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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neonatal white matter abnormalities an important predictor of neurocognitive outcome for very preterm children
Lianne J Woodward1, Caron A C Clark, Samudragupta Bora
1Canterbury Child Development Research Group, Department of Psychology, University of Canterbury, Christchurch, New Zealand. lianne.woodward@canterbury.ac.nz
Insights
Cerebral white matter abnormalities in very preterm infants predict cognitive impairments. However, preterm infants without these MRI findings at term appear to have normal cognitive development, suggesting white matter integrity is crucial for neurocognition.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Radiology
Background:
- Cerebral white matter abnormalities on MRI are linked to motor deficits in very preterm infants.
- The impact of these abnormalities on cognitive development is less understood.
Purpose of the Study:
- To investigate the relationship between the presence and severity of white matter abnormalities on neonatal MRI and neurocognitive outcomes at ages 4 and 6 years.
- To assess cognitive function in very preterm children with and without white matter abnormalities.
Main Methods:
- A cohort of 104 very preterm infants (≤32 weeks gestation) and 107 full-term infants were studied.
- Neonatal MRI scans of preterm infants were analyzed for white matter abnormalities (cysts, signal changes, volume loss, ventriculomegaly, corpus callosal thinning/myelination).
- Neurodevelopmental assessments covering intellectual ability, language, and executive functioning were conducted at corrected ages 4 and 6 years.
Main Results:
- Very preterm children without white matter abnormalities showed no cognitive impairments compared to full-term peers.
- Children with mild to moderate-to-severe white matter abnormalities exhibited performance deficits across all cognitive domains.
- The severity of white matter abnormalities correlated with increased risk of cognitive impairment, persisting after adjustments.
Conclusions:
- Cerebral white matter connectivity is vital for cognitive function in very preterm children.
- Preterm infants without term MRI white matter abnormalities may be protected from common cognitive impairments.
- Long-term follow-up is needed to confirm sustained cognitive outcomes into school age.
Background:
Cerebral white matter abnormalities on term MRI are a strong predictor of motor disability in children born very preterm. However, their contribution to cognitive impairment is less certain.
Objective:
Examine relationships between the presence and severity of cerebral white matter abnormalities on neonatal MRI and a range of neurocognitive outcomes assessed at ages 4 and 6 years.
Design/Methods:
The study sample consisted of a regionally representative cohort of 104 very preterm (≤32 weeks gestation) infants born from 1998-2000 and a comparison group of 107 full-term infants. At term equivalent, all preterm infants underwent a structural MRI scan that was analyzed qualitatively for the presence and severity of cerebral white matter abnormalities, including cysts, signal abnormalities, loss of white matter volume, ventriculomegaly, and corpus callosal thinning/myelination. At corrected ages 4 and 6 years, all children underwent a comprehensive neurodevelopmental assessment that included measures of general intellectual ability, language development, and executive functioning.
Results:
At 4 and 6 years, very preterm children without cerebral white matter abnormalities showed no apparent neurocognitive impairments relative to their full-term peers on any of the domain specific measures of intelligence, language, and executive functioning. In contrast, children born very preterm with mild and moderate-to-severe white matter abnormalities were characterized by performance impairments across all measures and time points, with more severe cerebral abnormalities being associated with increased risks of cognitive impairment. These associations persisted after adjustment for gender, neonatal medical risk factors, and family social risk.
Conclusions:
Findings highlight the importance of cerebral white matter connectivity for later intact cognitive functioning amongst children born very preterm. Preterm born children without cerebral white matter abnormalities on their term MRI appear to be spared many of the cognitive impairments commonly associated with preterm birth. Further follow-up will be important to assess whether this finding persists into the school years.
