Change in Volumes and Location of Preterm White Matter Injury over a Period of 15 Years

Area of Science:

• Neuroscience
• Neonatal Research
• Medical Imaging

Background:

• White matter injury (WMI) in preterm infants is a critical predictor of neurodevelopmental outcomes.
• Understanding temporal changes in WMI patterns is essential for improving infant brain health.
• Previous studies highlight the significance of WMI volume and spatial distribution.

Purpose of the Study:

• To investigate changes in the volume and spatial distribution of white matter injury (WMI) in preterm infants over a 15-year period.
• To assess if WMI patterns have evolved between two sequential prospective cohorts.
• To correlate changes in WMI with clinical factors and potential advancements in care.

Main Methods:

• Analysis of 528 infants born before 32 weeks' gestational age across two cohorts (2006-2012 and 2014-2019).
• Early-life and/or term-equivalent-age MRI scans were used to quantify WMI volumes via manual segmentation.
• Multivariable linear regression and lesion mapping were employed to analyze changes in WMI volume and location between cohorts, adjusting for confounders.

Main Results:

• A significant decrease in WMI volume was observed in the later cohort (cohort 2) compared to the earlier cohort (cohort 1).
• The spatial distribution of WMI shifted from a more central to a more posterior location over the study period.
• Infants in the later cohort exhibited decreased clinical illness severity, suggesting improvements in care.

Conclusions:

• White matter injury volume has decreased, and its location has shifted posteriorly in very preterm infants over 15 years.
• These findings may indicate enhanced white matter maturation at the time of injury.
• Observed changes in WMI are potentially linked to evolving clinical practices and improved management of preterm infants.