Brain microstructural antecedents of visual difficulties in infants born very preterm
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Preterm EEG: A Multimodal Neurophysiological Protocol
Published on: February 18, 2012
Rahul Chandwani1, Karen Harpster2, Julia E Kline1
1Center for Prevention of Neurodevelopmental Disorders, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
Insights
Very preterm infants with early visual-behavioral difficulties show micro and macrostructural brain abnormalities in visual pathways. These findings highlight the link between brain development and visual function in high-risk infants.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Medical Imaging
Background:
- Infants born very preterm (VPT) face risks for later visual problems.
- Neonatal screening identifies some ophthalmologic issues, but subtle brain injury contributes to complex visual-behavioral deficits.
- Understanding these brain-behavior links is crucial for early intervention.
Purpose of the Study:
- To investigate the micro and macrostructural brain antecedents of early visual-behavioral difficulties in VPT infants.
- To utilize diffusion MRI (dMRI) at term-equivalent age to assess visual pathway integrity.
- To correlate brain structure metrics with visual-behavioral outcomes.
Main Methods:
- A prospective cohort of 262 VPT infants (≤32 weeks gestational age) was recruited.
- Structural and diffusion MRI were acquired at term-equivalent age.
- Fixel-based analysis of dMRI data quantified white matter tract integrity (fiber density, cross-section).
- The Preverbal Visual Assessment (PreViAs) questionnaire assessed visual-behavioral function at 3-4 months corrected age.
- Multiple logistic regression analyzed associations between tract metrics and visual behavior.
Main Results:
- Diffusion MRI and PreViAs data were available for 191 VPT infants.
- Microstructural (fiber density) and macrostructural (fiber cross-section) alterations were observed in visual tracts in infants with retinopathy of prematurity.
- Combined metrics (FDC) of specific tracts (left posterior thalamic radiations, left inferior longitudinal fasciculus, left inferior fronto-occipital fasciculus) were significantly associated with visual attention scores.
- These associations remained significant after adjusting for key confounders like postmenstrual age and gestational age.
Conclusions:
- Early visual-behavioral difficulties in very preterm infants are associated with micro and macrostructural abnormalities in major visual pathways.
- Diffusion MRI at term-equivalent age can identify these early neural correlates.
- These findings underscore the importance of assessing brain development alongside visual function in VPT infants.
Abstract:
Infants born very preterm (VPT) are at risk of later visual problems. Although neonatal screening can identify ophthalmologic abnormalities, subtle perinatal brain injury and/or delayed brain maturation may be significant contributors to complex visual-behavioral problems. Our aim was to assess the micro and macrostructural antecedents of early visual-behavioral difficulties in VPT infants by using diffusion MRI (dMRI) at term-equivalent age. We prospectively recruited a cohort of 262 VPT infants (≤32 weeks gestational age [GA]) from five neonatal intensive care units. We obtained structural and diffusion MRI at term-equivalent age and administered the Preverbal Visual Assessment (PreViAs) questionnaire to parents at 3-4 months corrected age. We used constrained spherical deconvolution to reconstruct nine white matter tracts of the visual pathways with high reliability and performed fixel-based analysis to derive fiber density (FD), fiber-bundle cross-section (FC), and combined fiber density and cross-section (FDC). In multiple logistic regression analyses, we related these tract metrics to visual-behavioral function. Of 262 infants, 191 had both high-quality dMRI and completed PreViAs, constituting the final cohort: mean (SD) GA was 29.3 (2.4) weeks, 90 (47.1%) were males, and postmenstrual age (PMA) at MRI was 42.8 (1.3) weeks. FD and FC of several tracts were altered in infants with (N = 59) versus those without retinopathy of prematurity (N = 132). FDC of the left posterior thalamic radiations (PTR), left inferior longitudinal fasciculus (ILF), right superior longitudinal fasciculus (SLF), and left inferior fronto-occipital fasciculus (IFOF) were significantly associated with visual attention scores, prior to adjusting for confounders. After adjustment for PMA at MRI, GA, severe retinopathy of prematurity, and total brain volume, FDC of the left PTR, left ILF, and left IFOF remained significantly associated with visual attention. Early visual-behavioral difficulties in VPT infants are preceded by micro and macrostructural abnormalities in several major visual pathways at term-equivalent age.
