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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Relation between clinical risk factors, early cortical changes, and neurodevelopmental outcome in preterm infants
Karina J Kersbergen1, François Leroy2, Ivana Išgum3
1Department of Neonatology, Wilhelmina Children's Hospital and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
Insights
Preterm birth impacts early brain development. This study found that cortical folding in preterm infants is linked to clinical factors and predicts neurodevelopmental outcomes, especially language skills at two years.
Area of Science:
- Neuroscience
- Developmental Biology
- Pediatric Imaging
Background:
- Cortical folding, crucial for brain function, primarily occurs during the third trimester.
- Preterm birth may disrupt this critical developmental period, potentially affecting brain structure and long-term outcomes.
Purpose of the Study:
- To assess the development of specific cortical structures in extremely preterm infants from early MRI to term-equivalent age (TEA).
- To investigate the association between cortical folding, clinical characteristics, and neurodevelopmental outcomes at two years corrected age.
Main Methods:
- Magnetic resonance imaging (MRI) was used to evaluate cortical development in 71 extremely preterm infants at two time points: early age (~30 weeks postmenstrual age) and TEA (~40 weeks postmenstrual age).
- Clinical data and neurodevelopmental assessments at two years corrected age were analyzed in relation to cortical folding patterns.
Main Results:
- The central sulcus (CS), lateral fissure (LF), and insula (INS) were present in all infants early on; other sulci developed later. The superior frontal sulcus (SFS) showed the most relative growth. Asymmetry patterns varied, with the LF consistently showing leftward asymmetry.
- Lower birth weight z-score, multiple pregnancy, and prolonged mechanical ventilation negatively impacted early cortical folding, particularly for the earliest developing sulci.
- Cortical folding at early and TEA assessments was significantly associated with neurodevelopmental outcomes at two years corrected age, with receptive language showing a strong correlation.
Conclusions:
- Cortical development in preterm infants is influenced by both the timing of gestation and clinical factors.
- Early cortical folding patterns, especially sulcal development and asymmetry, serve as important indicators of neurodevelopmental trajectories, particularly for language abilities.
Abstract:
Cortical folding mainly takes place in the third trimester of pregnancy and may therefore be influenced by preterm birth. The aim of this study was to evaluate the development of specific cortical structures between early age (around 30weeks postmenstrual age) and term-equivalent age (TEA, around 40weeks postmenstrual age) in 71 extremely preterm infants, and to associate this to clinical characteristics and neurodevelopmental outcome at two years of age. First, analysis showed that the central sulcus (CS), lateral fissure (LF) and insula (INS) were present at early MRI in all infants, whereas the other sulci (post-central sulcus [PCS], superior temporal sulcus [STS], superior [SFS] and inferior [IFS] frontal sulcus) were only seen in part of the infants. Relative growth from early to TEA examination was largest in the SFS. A rightward asymmetry of the surface area was seen in development between both examinations except for the LF, which showed a leftward asymmetry at both time points. Second, lower birth weight z-score, multiple pregnancy and prolonged mechanical ventilation showed negative effects on cortical folding of the CS, LF, INS, STS and PCS, mainly on the first examination, suggesting that sulci developing the earliest were the most affected by clinical factors. Finally, in this cohort, a clear association between cortical folding and neurodevelopmental outcome at two years corrected age was found, particularly for receptive language.
