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Published on: October 28, 2022
Neonatal MRI is associated with future cognition and academic achievement in preterm children
Henrik Ullman1, Megan Spencer-Smith2, Deanne K Thompson3
11 Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden henrik.ullman@ki.se.
Insights
Neonatal brain imaging using deformation-based morphometry and diffusion tensor imaging can predict mathematical achievement in preterm children. These brain markers help identify infants at risk for cognitive impairments, enabling early intervention.
Area of Science:
- Neuroscience
- Developmental Psychology
- Medical Imaging
Background:
- Preterm birth (<30 weeks' gestational age) is linked to lower mathematical achievement in school-aged children.
- Working memory and number skills are critical for mathematical success and are often impaired in preterm infants.
- Early identification of at-risk preterm children via brain markers could facilitate timely intervention.
Purpose of the Study:
- To investigate the predictive utility of neonatal magnetic resonance imaging (MRI) measures for mathematical achievement.
- To assess working memory and early mathematical skills at ages 5 and 7 years in preterm children.
- To utilize automated MRI methods, including Jacobian maps and fractional anisotropy (FA) maps, for predicting cognitive outcomes.
Main Methods:
- A prospective longitudinal cohort study included preterm infants (<30 weeks' GA) and healthy controls (≥37 weeks' GA).
- Neonatal MRI was performed at term-equivalent age, with data analyzed using deformation-based morphometry (Jacobian maps) and diffusion tensor imaging (FA maps).
- Univariable (general linear model) and multivariable (support vector regression) models were employed to correlate brain measures with cognitive skills at 5 and 7 years.
Main Results:
- Neonatal Jacobian maps showed positive associations between insula/putamen regions and early mathematics at 5 and 7 years in preterm children (P < 0.05).
- Neonatal FA maps were positively associated with working memory and early mathematics at 5 years in preterm children (P < 0.001).
- These associations were significant in preterm infants but not in controls, even after adjusting for clinical factors.
Conclusions:
- Specific neonatal brain structural (Jacobian maps) and microstructural (FA maps) markers predict mathematical skills in preterm children.
- These findings support the clinical utility of neonatal MRI for identifying preterm infants at risk for cognitive and academic impairments.
- Early neuroimaging may guide interventions to improve long-term outcomes for preterm infants.
Abstract:
School-age children born preterm are particularly at risk for low mathematical achievement, associated with reduced working memory and number skills. Early identification of preterm children at risk for future impairments using brain markers might assist in referral for early intervention. This study aimed to examine the use of neonatal magnetic resonance imaging measures derived from automated methods (Jacobian maps from deformation-based morphometry; fractional anisotropy maps from diffusion tensor images) to predict skills important for mathematical achievement (working memory, early mathematical skills) at 5 and 7 years in a cohort of preterm children using both univariable (general linear model) and multivariable models (support vector regression). Participants were preterm children born <30 weeks' gestational age and healthy control children born ≥37 weeks' gestational age at the Royal Women's Hospital in Melbourne, Australia between July 2001 and December 2003 and recruited into a prospective longitudinal cohort study. At term-equivalent age ( ±2 weeks) 224 preterm and 46 control infants were recruited for magnetic resonance imaging. Working memory and early mathematics skills were assessed at 5 years (n = 195 preterm; n = 40 controls) and 7 years (n = 197 preterm; n = 43 controls). In the preterm group, results identified localized regions around the insula and putamen in the neonatal Jacobian map that were positively associated with early mathematics at 5 and 7 years (both P < 0.05), even after covarying for important perinatal clinical factors using general linear model but not support vector regression. The neonatal Jacobian map showed the same trend for association with working memory at 7 years (models ranging from P = 0.07 to P = 0.05). Neonatal fractional anisotropy was positively associated with working memory and early mathematics at 5 years (both P < 0.001) even after covarying for clinical factors using support vector regression but not general linear model. These significant relationships were not observed in the control group. In summary, we identified, in the preterm brain, regions around the insula and putamen using neonatal deformation-based morphometry, and brain microstructural organization using neonatal diffusion tensor imaging, associated with skills important for childhood mathematical achievement. Results contribute to the growing evidence for the clinical utility of neonatal magnetic resonance imaging for early identification of preterm infants at risk for childhood cognitive and academic impairment.
