Cognitive Development In Preterm Infants Research Articles

Differences in the amplitude of low-frequency fluctuations of spontaneous brain activity between preterm and term infants.

To date, the majority of research on resting-state functional magnetic resonance imaging (rs-fMRI) in the developing brain has primarily centered on adolescents and adults, leaving a gap in understanding variations in spontaneous brain activity at rest in preterm infants. This study aimed to uncover and comprehend the distinctions in spontaneous brain activity between preterm and term infants, with the goal of establishing a foundation for assessing the condition of preterm infants. In this study, 14 term infants and 15 preterm infants with equivalent gestational age were carefully chosen from the neonatal unit of Anhui Provincial Children's Hospital. The amplitude of low-frequency fluctuations (ALFF) intensity was assessed using resting-state functional magnetic resonance imaging (rs-fMRI) to examine brain activity in both groups. Subsequently, the differences between the term and preterm infants were statistically analyzed using a two-sample t-test. A p-value of <0.05, corrected for the REST Gaussian Random Fields, was deemed to be statistically significant. In comparison to the term infant group, the preterm infant group exhibited a significant increase in the ALFF value in the left precuneus, left frontal superior orbital gyrus, and left calcarine cortex. Significant variances in spontaneous brain activity have been observed in various regions between term infants and preterm infants of equivalent gestational age. These variations could potentially impact the emotional and cognitive development of preterm infants in the long term.

Cognitive assessment in preterms by Bayley-III: development in the first year and associated factors.

To analyze the cognitive development of preterm infants at six and 12 months of corrected age and the associations with perinatal and socioeconomic factors. Cognitive development of 40 infants (20 preterm and 20 full-term) at six and 12 months of age was evaluated using the Bayley-III scale. Correlations between cognitive outcome and associated factors were assessed using Spearman correlation. Stepwise multiple linear regression analysis with covariance was applied to identify changes on cognitive score between six and 12 months. Bayley-III cognitive score in preterm group was significantly lower than in full-term group at both six and 12 months of age. Birth weight correlated with cognitive performance at six months and head circumference at birth at 12 months, in full-terms infants. The occurrence of necrotizing enterocolitis was inversely associated with cognitive score in preterms at 12 months. An increase in cognitive score was observed between six and 12 months in both groups, but the gain was more pronounced in preterms. These findings suggest some cognitive recovery capacity in the first year despite the restrictions imposed by premature birth and emphasize the importance of early interventions in this population.

Old and new adventures with fatty acids and their oxylipins: The road towards personalised clinical nutrition

After paying homage to the work of E. Chevreul, Prof. Robert Gibson went on in a lighthearted way to find similarities in the way they both approached their respective fields of research, as well as their way of life. Prof. Robert Gibson, who was awarded the 2021 Chevreul Medal, reported that “his huge delight was to witness the massive growth of lipid research and to have played a role in elucidating the role of dietary fats in the health of mothers and their babies”. Prof. Gibson highlighted some of the major results he collected from Australian clinical studies conducted on the role of omega-3 fatty acids on the health outcomes of mothers and their infants. He first discussed the role of fish oil on visual acuity of babies and demonstrated that infant formulas supplying more than 1% of linolenic acid (ALA) seemed adequate to ensure optimal visual and cognitive development of term infants. However, in preterm infants, whether there is a specific need for DHA above the benefit provided by ALA, still needs to be clarified. He reported a small beneficial impact on the cognitive development of preterm infants receiving DHA enriched breast milk of their mothers (1% of total fatty acids). He then discussed data from his large randomised clinical trials conducted on pregnant women receiving a DHA dietary treatment (800 mg/d DHA) or placebo, that suggested that DHA may decrease the risk of preterm birth (DOMInO trial, 2400 women). This effect was confirmed in the ORIP trial (5400 women) which found that preterm birth could be prevented by a DHA supplement treatment mainly in women with a singleton pregnancy who had a low omega-3 status in the first trimester. In the last part of his review, Robert Gibson described the use of a new low cost, rapid and efficient method to monitor changes in blood levels of omega-3 fatty acids with clinical outcomes: the Dried Blood Spots (DBS) technology. The validation of this technique has been demonstrated in large trials like N3RO and ORIP involving large cohorts of women, which could not have been obtained easily by classical analysis of lipids. He went on to point out that free fatty acids (generally not explored despite their importance in many metabolic disorders) and oxylipins, are both stable and easily identified when they are preserved in a dry state on a paper matrix (DBS), thus opening new fields of research. To conclude, the major impact of Prof. Robert Gibson’s work was identifying and overcoming one of the causes of early preterm birth (omega-3 deficiency), developing a tool to rapidly assess omega-3 status (the DBS technique) that together is close to being implemented into the world health system.

The cerebral hemodynamic response to phonetic changes of speech in preterm and term infants: The impact of postmenstrual age.

Higher brain dysfunction, such as language delay, is a major concern among preterm infants. Cerebral substrates of cognitive development in preterm infants remain elusive, partly because of limited methods. The present study focuses on hemodynamic response patterns for brain function by using near-infrared spectroscopy. Specifically, the study investigates gestational differences in the hemodynamic response pattern evoked in response to phonetic changes of speech and cerebral hemispheric specialization of the auditory area in preterm infants (n = 60) and term infants (n = 20). Eighty neonates born between 26 and 41 weeks of gestational age (GA) were tested from 33 to 41 weeks of postmenstrual age (PMA). We analyzed the hemodynamic response pattern to phonemic and prosodic contrasts for multiple channels on temporal regions and the laterality index of the auditory area. Preterm infants younger than 39 weeks of PMA showed significantly atypical hemodynamic patterns, with an inverted response shape. Partial correlation analysis of the typicality score of hemodynamic response revealed a significant positive correlation with PMA. The laterality index of preterm infants from 39 weeks of PMA demonstrated a tendency rightward dominance for prosodic changes similar to term infants. We provide new evidence that alterations in hemodynamic regulation and the functional system for phonemic and prosodic processing in preterm infants catch up by their projected due dates.

Cognitive development in preterm infants: multifaceted deficits reflect vulnerability of rigorous neurodevelopmental pathways.

Prematurity remains the major cause of neonatal morbidity and mortality, with 15 million preterm births occurring worldwide in 2010. Infants born less than 37 weeks gestation are at high risk of abnormal neurodevelopmental outcomes, given that the central nervous system is extremely sensitive to an abnormal intra- and extra-uterine environment. Children born preterm have multiple neurodevelopmental sequelae involving dynamic and complex cognitive deficits. Former preterm infants have difficulty with each domain of cognition, including executive function, language, learning and memory, complex attention, perceptual-motor function and social cognition when compared to children born at term. Although deficits are not always severe, even mild delays can be impactful, resulting in a spectrum of outcomes from difficulties in school to an inability to lead an independent adult life. Here, we review current literature on the cognitive outcomes of infants born preterm with a focus on how specific disruption in crucial neurodevelopmental pathways render these children vulnerable to dynamic deficits in cognition as they mature. Further, we highlight promising therapies and intervention strategies aimed at mitigating these deficits, including the use of erythropoietin. With an increasing number of preterm infants surviving, understanding developmental deficits will allow therapies to be developed and optimized, in order to ensure the best outcome for this vulnerable patient population.

Relationship between insulin-like growth factor 1, leptin and ghrelin levels and catch-up growth in small for gestational age infants of 27-31 weeks during neonatal intensive care unit admission.

Poor post-natal growth is related to later morbidity and poor cognitive development in preterm infants. We investigated the relationship between plasma insulin-like growth factor 1 (IGF-1), leptin, active ghrelin levels and post-natal growth in preterm infants small for gestational age (SGA). Plasma IGF-1, leptin and active ghrelin levels were measured at birth and at 2, 4, 6 and 8 weeks after birth in 42 very low birthweight (VLBW) infants (born between 27 and 31 weeks of gestation), including 14 SGA infants with extrauterine growth restriction (EUGR), 6 SGA infants without EUGR and 22 appropriate-for-gestational-age infants. At birth, IGF-1 levels in SGA infants without EUGR did not differ significantly from those in SGA infants with EUGR. However, IGF-1 levels in SGA infants without EUGR were as high as those observed in appropriate-for-gestational-age infants and were significantly different from those in SGA infants with EUGR at 4 and 8 weeks of age. Leptin and ghrelin levels did not differ significantly among the three groups at any time point. IGF-1 is related to catch-up growth in SGA VLBW infants during neonatal intensive care unit admission; however, this does not appear to be the case for leptin and ghrelin. IGF-1 level monitoring may be useful for predicting EUGR in preterm VLBW infants.

Improved Cognitive Development in Preterm Infants with Shared Book Reading.

To examine the effect of shared book reading on the cognitive development of children born preterm and to determine what factors influence shared book reading in this population. Secondary analysis using the Early Childhood Longitudinal Study-Birth Cohort, a large, nationally representative survey of children born in the United States in 2001. One thousand four hundred singleton preterm infants (22-36 weeks gestation). Cognitive development measured using the Bayley Mental Scale score from the Bayley Scales of Infant Development Research Edition. Adjusting for neonatal, maternal, and socioeconomic characteristics, reading aloud more than two times a week is associated with higher cognitive development scores in two-year-old children born preterm (p < .001). Race/ethnicity and maternal education affect how often parents read to their children. Shared book reading holds potential as an early developmental intervention for this population.

Long-Chain Polyunsaturated Fatty Acids in Breast-Milk and Erythrocytes and Neurodevelopmental Outcomes in Danish Late-Preterm Infants

Background: The supply of long-chain polyunsaturated fatty acids (LC-PUFA) during pregnancy and early lactation has been shown to affect cognitive development in preterm infants, but the effect on early neurodevelopment of late-preterm infants has not yet been examined. Aim: To examine the fatty acid composition of late-preterm human milk and identify possible associations between infant LC-PUFA status and perinatal as well as 1-year neurobehavioral outcomes. Methods: Mother’s milk and erythrocytes (RBC) were sampled from 53 Danish late-preterm infants (33-36 weeks of gestation) 1 week and 1 month after delivery, and 3 months corrected age. Fatty acid composition was determined by gas-liquid chromatography. Neurodevelopmental outcomes were assessed by the Nicu Network Neurobehavioral Scale (NNNS) at 1 week and 1 month and the Bayley Scales (BSID-III) at 1 year corrected age. Results: We found that breast-milk content of arachidonic acid (AA) and docosahexaenoic acid (DHA) was similar to reported fatty acid compositions of term human milk. Infant RBC-AA decreased from 1 week to 1 month of age and the size of the decrease was associated with better NNNS-scores at 1 month, specifically on regulation (p=0.03). Infant RBC-AA at 1 month was also associated with a lower 1-year corrected age BSID-III score of receptive language (p=0.05) and fine motor development (p=0.03). Infant RBC-DHA did not decrease significantly after delivery and was not associated with any of the developmental outcomes. Conclusion: Breast-milk LC-PUFA content was reflected in the RBC LC-PUFA status of the infant. Early RBC-AA status was associated with both early and long-term neurobehavioral development, but not in a consistent way.

Automatically Quantified Diffuse Excessive High Signal Intensity on MRI Predicts Cognitive Development in Preterm Infants

BackgroundCognitive and language impairments constitute the majority of disabilities observed in preterm infants. It remains unclear if diffuse excessive high signal intensity on magnetic resonance imaging at term represents delayed white matter maturation or pathology. MethodsWe hypothesized that diffusion tensor imaging–based objectively quantified diffuse excessive high signal intensity measures at term will be strong predictors of cognitive and language development at 2 years in a cohort of 41 extremely low birth weight (≤1000 g) infants. Using an automated probabilistic atlas, mean diffusivity maps were used to objectively segment and quantify diffuse excessive high signal intensity volume and mean, axial, and radial diffusivity measures. Standardized neurodevelopment was assessed at 2 years of age using the Bayley Scales of Infant Development, third edition. ResultsThirty-six of the 41 infants (88%) had complete developmental data at follow-up. Objectively quantified diffuse excessive high signal intensity volume correlated significantly with cognitive and language scores at 2 years (P < 0.001 for both). The sum values of the three diffusivity measures in detected diffuse excessive high signal intensity regions also correlated significantly with the Bayley scores (r2 34.7%; P < 0.001 for each). Infants in the highest quartile for diffuse excessive high signal intensity volumes had scores between 19 and 24 points lower than infants in the lowest quartile (P < 0.01). When diagnosed subjectively by neuroradiologists however, Bayley scores were not significantly lower in infants with extensive diffuse excessive high signal intensity. ConclusionsThese findings lend further evidence that diffuse excessive high signal intensity is pathologic and that objectively quantified diffusion-based diffuse excessive high signal intensity volume at term is associated with cognitive and language impairments. Our approach could be used for risk stratification and early intervention for such high-risk extremely preterm infants.

Long-term cognitive and neurological outcome of preterm infants with postnatally acquired CMV infection through breast milk

IntroductionLong-term follow-up data on preterm infants with breast milk–acquired postnatal cytomegalovirus (CMV) infection are sparse.AimTo systematically evaluate the long-term cognitive outcome and prevalence of cerebral palsy (CP) in patients after...

Cerebellar volume and proton magnetic resonance spectroscopy at term, and neurodevelopment at 2 years of age in preterm infants

To assess the relation between cerebellar volume and spectroscopy at term equivalent age, and neurodevelopment at 24 months corrected age in preterm infants. Magnetic resonance imaging of the brain was performed around term equivalent age in 112 preterm infants (mean gestational age 28wks 3d [SD 1wk 5d]; birthweight 1129g [SD 324g]). Cerebellar volume (60 males, 52 females), and proton magnetic resonance spectroscopy ((1) H-MRS) of the cerebellum in a subgroup of 58 infants were assessed in relation to cognitive, fine motor, and gross motor scores on the Bayley Scales of Infant and Toddler Development-III. Different neonatal variables and maternal education were regarded possible confounders. Cerebellar volume was significantly associated with postmenstrual age at time of magnetic resonance imaging. Cerebellar volume corrected for postmenstrual age was significantly and positively associated with cognition. Cognitive scores related significantly with N-acetylaspartate/choline (NAA/Cho) ratio obtained from cerebellar (1) H-MRS in 53 infants. Correction for neonatal and maternal variables did not change these results. Cerebellar variables were not related to motor performance. In preterm infants, both cerebellar volume and cerebellar NAA/Cho ratio at term equivalent age were positively associated with cognition; however, no relation was found with motor outcome at 2 years of age. These findings support the importance of the cerebellum in cognitive development in preterm infants.

Individual differences in postural control and cognitive development in preterm infants

This study was aimed to examine whether individual differences in postural control at 6 months of age could predict cognitive development and attention in relatively healthy preterm infants 6–18 months later. Three groups of infants were identified on the basis of a behavioral observation during an exploration task: infants with an adequate postural control ( N=33), infants who showed extension of the elbows consistently ( N=23), and infants who demonstrated clear signs of hyperextension of neck and trunk ( N=9). In contrast to infants with an adequate postural control, infants who showed signs of hyperextension or elbow extension scored significantly lower on several cognitive measures (Bayley mental scale and tasks for problem solving) and were significantly more often not attending to a task, 6–18 months later. This study showed that individual differences in postural control could predict later cognitive development and inattention of infants who were born prematurely.

The Use of Low-EPA Fish Oil for Long-Chain Polyunsaturated Fatty Acid Supplementation of Preterm Infants

Because docosahexaenoic acid (DHA) may be an essential nutrient for the visual and early cognitive development of preterm infants, DHA enrichment of preterm formulas has been recommended. This randomized trial was designed to study the n-6 and n-3 fatty acid status of healthy preterm infants fed a formula enriched with a low eicosapentaenoic-fish oil until 4 mo corrected age compared with that of infants fed a standard formula. A reference group of breast-fed infants was studied concurrently. The fatty acid content of red blood cell (RBC) phospholipid was assessed at enrollment, hospital discharge, expected term, and 3 and 6 mo postterm. The DHA content of RBC phospholipid was higher in infants fed the enriched versus the standard formula at hospital discharge, expected term, and 3 and 6 mo postterm. However, compared with infants fed the standard formula, infants fed the enriched formula had also higher RBC phospholipid eicosapentaenoic content (0.69 +/- 0.15% versus 0.25 +/- 0.12%, p < 0.001), and lower RBC phospholipid arachidonic acid content (15.1 +/- 0.93% versus 18.8 +/- 0.89%; p < 0.001). We conclude that supplementing preterm infants with low-eicosapentaenoic fish oil is effective in improving DHA status, but results in worsening of n-6 fatty acid status. We speculate that preterm infants may require a dietary supply of arachidonic acid as well as DHA if the same fatty acid status as that of breast-fed infants is to be achieved.

Effects of severity and chronicity of respiratory illness on the cognitive development of preterm infants.

Effects of severity and chronicity of respiratory illness on the cognitive development of preterm infants.

Cognitive Development in Preterm Infants: Birth to 8 Years

This report summarizes the outcome at age 8 of a group of preterm infants followed intensively from birth. The study was designed primarily to follow the processes of interaction between biological and environmental factors in determining the childhood outcome of infants born preterm rather than to report the incidence of particular types of outcomes for special subgroups of infants. A high percentage of the children were performing within the normal range. Social factors played a major role in determining the outcome regardless of neonatal complications. Functional assessment of newborn visual attention and sleep organization showed a modest relation to outcome. A subgroup of preterm infants from Spanish-speaking families, for cultural and language integration reasons, followed a somewhat different course from infancy to childhood outcome than did the group from English-speaking families. The results suggest that in longitudinal studies of preterm infants, different cultural and language groups should be analyzed separately so that one may understand the developmental processes and outcomes.

Caregiver-Infant Interaction and Early Cognitive Development in Preterm Infants

BECKWITH, LEILA; COHEN, SARALE E.; KoPP, CLAIRE, B.; PARMELEE, ARTHUR, H.; and MARCY, TONI G. Caregiver-Infant Interaction and Early Cognitive Development in Preterm Infants. CHILD DEVELOPMENT, 1976, 47, 579-587. Caregiver-infant transactions with 51 infants who were born prematurely were studied in naturalistic observations in the home when the infants were aged 1, 3, and 8 months. Gesell developmental schedules and a sensorimotor scale were administered at 9 months. The results indicated that environmental encounters operate differentially in influencing sensorimotor development and Gesell DQ, although the influences were not mutually exclusive. Infants who achieved higher DQs spent less of their awake time at 1 and 3 months receiving physical care, they experienced more postural stress when being held, and they had increased opportunity in floor freedom at 8 months. Infants who achieved higher sensorimotor scores at 9 months had experienced more mutual caregiver-infant gazing at 1 month; at 3 months, more interchanges of smiling during gazing and more contingent responses to distress; and at 8 months, more general attentiveness as well as more contingent responses to nondistress vocalizations.

Caregiver-Infant Interaction and Early Cognitive Development in Preterm Infants

Caregiver-Infant Interaction and Early Cognitive Development in Preterm Infants