Regional white matter development in very preterm infants: perinatal predictors and early developmental outcomes

Area of Science:

• Neonatal neuroscience
• Neuroimaging
• Developmental pediatrics

Background:

• Preterm infants face risks of white matter (WM) injury and long-term neurodevelopmental challenges.
• Early brain development is crucial for long-term outcomes.

Purpose of the Study:

• To investigate regional white matter (WM) maturation in very preterm infants using diffusion tensor magnetic resonance imaging (dMRI).
• To explore the relationship between dMRI-derived diffusion measures and neurodevelopmental outcomes at two years of age.

Main Methods:

• Serial dMRI scans were acquired from 78 very preterm infants (born <30 weeks gestation) between 26-42 weeks postmenstrual age.
• Fractional anisotropy (FA) and mean diffusivity (MD) slopes were calculated in specific white matter regions for 50 infants with at least two scans.
• Neurodevelopmental testing was performed at two years of age for 65 children.

Main Results:

• The posterior limb of the internal capsule showed the greatest FA slope, indicating rapid maturation.
• Maturation (FA slope) in the anterior limb of the internal capsule, corpus callosum, and optic radiations increased with gestational age.
• Lower FA slope in the anterior limb of the internal capsule was associated with patent ductus arteriosus; lower MD slope correlated with prolonged ventilation or lack of antenatal steroids.
• Altered FA values at term-equivalent age were linked to motor scores and social-emotional competence at two years.

Conclusions:

• White matter maturation exhibits regional variability in susceptibility to perinatal influences.
• Altered diffusion measures in preterm infants are associated with subsequent neurodevelopmental outcomes, underscoring the importance of early brain assessment.