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Circulatory insulin-like growth factor-I and brain volumes in relation to neurodevelopmental outcome in very preterm
Ingrid Hansen-Pupp1, Holger Hövel, Chatarina Löfqvist
1Department of Pediatrics, Institute of Clinical Sciences, Lund, Skane University Hospital, Lund University, Lund, Sweden.
Insights
A faster increase in insulin-like growth factor-I (IGF-I) in very preterm infants is linked to better cognitive development. This association is partly explained by brain volume at term-equivalent age.
Area of Science:
- Neonatalogy
- Developmental Pediatrics
- Pediatric Neurology
Background:
- Very preterm infants face risks for neurodevelopmental impairments.
- Circulating insulin-like growth factor-I (IGF-I) plays a crucial role in brain development.
- Understanding factors influencing neurodevelopment in this population is critical.
Purpose of the Study:
- To investigate the relationship between postnatal IGF-I growth trajectories and neurodevelopmental outcomes at 2 years corrected age.
- To assess the association between brain volumes (total brain, cerebellum, gray matter, unmyelinated white matter) and developmental outcomes.
- To determine if brain volumes mediate the effect of IGF-I on neurodevelopment.
Main Methods:
- Weekly IGF-I measurements and daily nutritional intake tracking from birth to 35 weeks postmenstrual age (PMA).
- Calculation of individual IGF-I growth coefficients (IGF-I(B)).
- Brain MRI at term-equivalent age for volumetric analysis; Bayley Scales of Infant Development-II for neurodevelopmental assessment at 2 years.
Main Results:
- Higher IGF-I(B) was associated with a reduced risk of subnormal Mental Developmental Index (MDI < 85).
- Larger unmyelinated white matter volume (UWMV) and cerebellar volume were also linked to better MDI.
- Multivariate models indicated that higher IGF-I(B) and UWMV, particularly in females, predicted higher MDI (> 85).
Conclusions:
- An accelerated postnatal increase in IGF-I is associated with improved neurodevelopmental outcomes in very preterm infants.
- Brain volumes, specifically UWMV and cerebellar volume, are significant predictors of neurodevelopment.
- The positive effect of IGF-I on neurodevelopment is partially mediated by brain structure at term-equivalent age.
Background:
To evaluate the relationships between postnatal change in circulatory insulin-like growth factor-I (IGF-I) concentrations, brain volumes, and developmental outcome at 2 y of age in very preterm infants.
Methods:
IGF-I was measured weekly, and nutritional intake was calculated daily from birth until a postmenstrual age (PMA) of 35 wk. Individual β coefficients for IGF-I, IGF-I(B), representing the rate of increase in IGF-I from birth until a PMA of 35 wk were calculated. Brain magnetic resonance imaging was performed at term age, with segmentation into total brain, cerebellar, gray matter, and unmyelinated white matter volume (UWMV). Developmental outcome was evaluated using Bayley Scales of Infant Development-II.
Results:
Forty-nine infants, with mean gestational age (GA) of 26.0 wk, were evaluated at mean 24.6 mo corrected age. Higher IGF-I(B), UWMV, and cerebellar volume were associated with a decreased risk for a Mental Developmental Index (MDI) < 85 (odds ratio (95% confidence interval): 0.6 (0.4-0.9), 0.96 (0.94-0.99), and 0.78 (0.6-0.96), respectively). In multivariate analysis, higher IGF-I(B) and higher UWMV combined with female gender constituted the two models with the highest predictive value for MDI > 85.
Conclusion:
A higher rate of increase in circulating IGF-I is associated with a decreased risk for subnormal MDI at 2 y of corrected age. This relationship is in part dependent on brain volume at term age.
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