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Functional Connectivity Relationships to Longitudinal Motor Outcomes Differ in Very Preterm Children With and Without

Peppar E P Cyr1, Rachel E Lean1, Jeanette K Kenley1

  • 1Departments of Neurology (PEPC, JKK, SK, DM, JJN, DA, RGB, CDS), and Psychiatry (REL, CER), Washington University School of Medicine; Mallinckrodt Institute of Radiology (JSS, CDS); Department of Psychology (TLR), Washington University in St. Louis; and Department of Pediatrics (CER, CDS), Washington University School of Medicine, St. Louis, MO.

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Functional connectivity (FC) in very preterm (VPT) infants predicts motor outcomes. Neonatal FC disruptions in uninjured VPT children may lead to later motor deficits not apparent at age 2.

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Area of Science:

  • Neuroscience
  • Developmental Pediatrics
  • Medical Imaging

Background:

  • Very preterm (VPT) infants face high risks of motor disabilities.
  • Early identification of motor deficits in VPT children is challenging, particularly for those developing issues later in childhood.
  • Functional connectivity (FC) MRI offers a potential tool for early assessment.

Purpose of the Study:

  • To investigate the relationship between functional connectivity (FC) measured at term-equivalent age and motor outcomes at 2 and 5 years in very preterm (VPT) children.
  • To identify early neural markers for motor development in VPT infants, with or without brain injury.

Main Methods:

  • A longitudinal observational cohort study involving VPT infants (gestational age ≤30 weeks).
  • Functional connectivity (FC) MRI was performed at term-equivalent age.
  • Motor development was assessed at 2 and 5 years using standardized scales (Bayley Scales and Movement Assessment Battery for Children).
  • Statistical models examined the association between FC measures and motor outcomes, considering brain injury status.

Main Results:

  • In VPT children with brain injury, reduced left-right motor cortex FC correlated with increased odds of fine motor task inability at age 5.
  • In uninjured VPT children, altered basal ganglia-motor cortex FC was linked to poorer fine motor skills, and cerebellum-motor cortex FC to poorer balance and fine motor skills at age 5.
  • These motor deficits in uninjured children emerged by age 5, despite normal 2-year assessments.

Conclusions:

  • Neonatal FC can predict motor deficits in VPT children, both with and without brain injury.
  • Motor planning and coordination difficulties in uninjured VPT children may stem from early neural disruptions, becoming apparent later in development.
  • Continuous motor monitoring is recommended for VPT children, as 2-year assessments may miss milder deficits. FC at term-equivalent age shows promise for early disability prediction.