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Published on: January 7, 2018
Young adults born preterm with very low birth weight demonstrate widespread white matter alterations on brain DTI
Live Eikenes1, Gro C Løhaugen, Ann-Mari Brubakk
1Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway. live.eikenes@ntnu.no
Insights
Very low birth weight preterm infants show lasting white matter integrity issues into adulthood, impacting cognitive function. These long-term effects are linked to prematurity severity and intensive care duration.
Area of Science:
- Neuroscience
- Developmental Biology
- Radiology
Background:
- Preterm birth with very low birth weight (VLBW) is associated with white matter (WM) integrity deficits.
- These WM changes correlate with motor, sensory, and neuropsychological impairments.
- The long-term impact of VLBW on CNS myelination into adulthood remains under-explored.
Purpose of the Study:
- To investigate white matter (WM) integrity differences in young adults born preterm with VLBW compared to term-born controls.
- To explore correlations between perinatal factors, cognitive ability, and WM integrity metrics in VLBW survivors.
Main Methods:
- Diffusion Tensor Imaging (DTI) and Tract-Based Spatial Statistics (TBSS) were employed.
- Voxelwise comparisons of fractional anisotropy (FA) and mean diffusivity (MD) were performed between VLBW (n=49) and control (n=59) groups aged 18-22 years.
- Relationships between DTI metrics and clinical data (birth weight, intensive care) and cognitive scores (total IQ) were analyzed.
Main Results:
- VLBW adults exhibited significantly reduced FA in posterior WM tracts, linked to increased eigenvalues.
- Increased MD was observed in VLBW individuals, particularly in peripheral WM regions.
- Reduced FA correlated with lower birth weight, longer intensive care, and mechanical ventilation duration; FA positively correlated with total IQ in VLBW adults, unlike controls.
Conclusions:
- Neurologic sequelae of VLBW preterm birth persist into adulthood, causing lifelong structural and functional impairments.
- Reduced WM integrity in adulthood is a significant consequence for VLBW survivors.
- Neonatal immaturity, mechanical ventilation, and prolonged intensive care represent the highest risk factors for impaired adult WM integrity.
Abstract:
Preterm birth with very low birth weight (VLBW, ≤1500 g) is connected to reduced white matter (WM) integrity in childhood and adolescence. These changes in WM are correlated to motor, sensory and neuropsychological impairments. CNS myelination continues into the early twenties, but the consequences of this for WM integrity in VLBWs have not been explored. DTI and tract based spatial statistics (TBSS) was carried out to test for voxelwise differences in fractional anisotropy (FA), eigenvalues and mean diffusivity (MD) between a preterm VLBW group (n=49) and a control group born at term (n=59) at 18-22 years of age. TBSS was also used to explore the relationship between perinatal clinical data and general cognitive ability (total IQ), respectively, and the DTI metrics (FA and MD), with gender and age as a confounder. In the VLBW group several major WM tracts particularly in the posterior region had significantly reduced FA caused by an increase in the two lowest eigenvalues. MD was significantly increased in the VLBWs in 50% of the same regions as the FA changes, but encompassing also more peripheral WM. In the VLBW group, FA was found to correlate positively with birth weight and negatively with number of days in intensive care and on mechanical ventilator, particularly in the corpus callosum. FA was found to correlate positively with total IQ in the young preterm adults. In the controls there was no correlation between FA and total IQ. Our results indicate that the neurologic sequelae of preterm birth with VLBW are a lifelong condition inducing structural and functional impairments also in adulthood in VLBW survivors. The greatest risk of having reduced WM integrity in adulthood was found in the most immature VLBW neonates requiring mechanical ventilation and long-term intensive care.
