Linking integrity of visual pathways trajectories to visual behavior deficit in very preterm infants

Low-risk premature infants often develop visual deficits, even in the absence of ophthalmological complications and high-graded brain injury. These complications can be explained by the nature of subtle perinatal lesions and alterations of brain growth due to the prematurity. Subtle brain injuries and vulnerability of axonal pathways can be observed in spatiotemporal context of the white matter segments. The aim of this study was to examine the link between MRI quantitative (brain metrics data) and qualitative features (visibility of 2nd white matter segment - sagittal strata and periventricular crossroads C1-C6) and visual behavior in preterm neonates at term-equivalent age. Seventy-one very preterm infants without high-graded brain injury on MRI and no ocular pathologies were studies. The infants received MRI scans at term-equivalent age. MRI scans were analyzed using (a) simple brain metrics and (b) scoring the visibility of transient structural patterns (sagittal strata and periventricular crossroads). At the median age of 41⁺⁵ PMA weeks infants completed the Neonatal Visual Assessment. Results indicated that visibility of temporal crossroad area C6 and frontal and occipital sagittal strata was positively correlated with visual tracking skills in neonatal period. Furthermore, the visibility of frontal and occipital sagittal strata were strong predictors of total Neonatal Visual Assessment score. The findings confirmed that sagittal strata and periventricular crossroads prominence is a valuable additional marker in perinatal neuroimaging at term-equivalent age. Thus, alteration in MRI appearance of temporal crossroad and sagittal strata may be useful in predicting of visual behavior for very premature born infants.