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Published on: November 20, 2015
Regional white matter microstructure in very preterm infants: predictors and 7 year outcomes
Deanne K Thompson1, Katherine J Lee2, Gary F Egan3
1Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Vic, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Carlton, Vic, Australia.
Insights
Very preterm infants show altered white matter microstructure compared to full-term infants, with increased diffusivity linked to perinatal factors and later motor and executive function impairments.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Radiology
Background:
- Very preterm (VPT) infants often experience white matter abnormalities.
- Understanding these microstructural differences is crucial for predicting neurodevelopmental outcomes.
Purpose of the Study:
- Investigate white matter microstructural differences between VPT and full-term (FT) infants.
- Explore perinatal predictors of diffusion measures.
- Examine the relationship between white matter diffusion and neurodevelopmental outcomes at age 7 in VPT children.
Main Methods:
- Diffusion tensor imaging (DTI) was used to assess white matter microstructure in VPT and FT infants at term corrected age.
- Perinatal factors and neurodevelopmental outcomes at 7 years were analyzed.
Main Results:
- VPT infants exhibited increased mean, axial, and radial diffusivity in total white matter compared to FT infants.
- Perinatal white matter abnormality and severe intraventricular hemorrhage were associated with increased white matter diffusivity in VPT infants.
- Higher white matter diffusivity in the inferior occipital and cerebellar regions at term-equivalent age predicted motor and executive function impairments at 7 years.
Conclusions:
- Myelination is likely disrupted or delayed in VPT infants, particularly those with perinatal brain abnormalities.
- Altered white matter diffusivity in infancy is linked to impaired motor and executive functioning later in childhood.
- This study highlights the long-term impact of early white matter alterations on neurodevelopment in VPT children.
Abstract:
The aims of this study were to investigate regional white matter microstructural differences between very preterm (VPT) (<30 weeks' gestational age and/or <1250 g) and full term (FT) (≥37 weeks' gestational age) infants at term corrected age with diffusion tensor imaging, and to explore perinatal predictors of diffusion measures, and the relationship between regional diffusion measures and neurodevelopmental outcomes at age 7 years in VPT children. Mean (MD) (p = .003), axial (AD) (p = .008), and radial diffusivity (RD) (p = .003) in total white matter were increased in VPT compared with FT infants, with similar fractional anisotropy (FA) in the two groups. There was little evidence that group-wise differences were specific to any of the 8 regions studied for each hemisphere. Perinatal white matter abnormality and intraventricular hemorrhage (grade III or IV) were associated with increased diffusivity in the white matter of VPT infants. Higher white matter diffusivity measures of the inferior occipital and cerebellar region at term-equivalent age were associated with increased risk of impairments in motor and executive function at 7 years in VPT children, but there was little evidence for associations with IQ or memory impairment. In conclusion, myelination is likely disrupted or delayed in VPT infants, especially those with perinatal brain abnormality (BA). Altered diffusivity at term-equivalent age helps explain impaired functioning at 7 years. This study defines the nature of microstructural alterations in VPT infant white matter, assists in understanding the associated risk factors, and is the first study to reveal an important link between inferior occipital and cerebellar white matter disorganization in infancy, and executive and motor functioning 7 years later.
