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Published on: November 20, 2015
Associations of Bronchopulmonary Dysplasia and Infection with School-Age Brain Development in Children Born Preterm
Caroline Kim1, Steven Ufkes2, Ting Guo3
1Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Pediatrics, BC Children's Hospital Research Institute and the University of British Columbia, Vancouver, BC, Canada.
Insights
Bronchopulmonary dysplasia (BPD) and infections in preterm infants distinctly impact brain development, leading to poorer motor, visual-motor, and cognitive outcomes by age 8. Targeted interventions are suggested based on these nonuniform effects.
Area of Science:
- Neonatal Medicine
- Neuroscience
- Developmental Pediatrics
Background:
- Bronchopulmonary dysplasia (BPD) and culture-positive infections are common complications in preterm infants.
- These conditions may impact long-term neurodevelopment and brain structure, particularly white matter maturation.
- Understanding these associations is crucial for optimizing developmental outcomes in this vulnerable population.
Purpose of the Study:
- To investigate the association of bronchopulmonary dysplasia (BPD) and culture-positive infection with neurodevelopmental outcomes and white matter maturation at 8 years of age in children born preterm.
- To differentiate the specific neurodevelopmental trajectories and white matter changes associated with BPD versus infection.
Main Methods:
- Prospective cohort study of 164 preterm infants (gestational age 24-32 weeks) followed to 8 years.
- Neurodevelopmental assessments included IQ, working memory, visual-motor integration, and motor skills.
- Diffusion tensor imaging (DTI) was used to assess white matter integrity via fractional anisotropy (FA).
Main Results:
- BPD was associated with significant decreases in motor and visual-motor scores at age 8.
- Culture-positive infection was linked to lower IQ scores at age 8.
- BPD correlated with left-hemisphere FA reductions (worse motor/visual-motor outcomes), while infection correlated with bilateral FA reductions (lower IQ/poorer working memory).
Conclusions:
- Bronchopulmonary dysplasia and culture-positive infection have distinct, detrimental effects on white matter development and neurodevelopmental outcomes in children born very preterm.
- Neonatal illnesses affect the developing brain in a nonuniform manner.
- These findings highlight the need for targeted interventions based on the specific neonatal morbidities experienced.
Objective:
To determine the association of bronchopulmonary dysplasia (BPD) and culture-positive infection with neurodevelopment and white matter maturation at 8 years of age in children born preterm.
Study Design:
Prospective cohort study of 164 children born at 24-32 weeks of gestation followed to 8 years of age (89 male, median [IQR] age: 8.24 [8.07-8.58] years). At age 8, IQ (Weschler Abbreviated Scale of Intelligence, second Ed), working memory (Wechsler Intelligence Scale for Children, fifth Ed), visual-motor (Beery-Buktenica Developmental Test of Visual-Motor Integration sixth Ed), and motor outcomes (Movement Assessment Battery for Children-2) were assessed. Diffusion tensor imaging and tract-based spatial statistics were used to assess fractional anisotropy (FA).
Results:
Fifty of 164 children had BPD and 72/164 had culture-positive infection. At 8 years, BPD was associated with a 9.8-point decrease in motor (CI -17.9 to -1.8, P = .02) and 6.0-point decrease in visual-motor scores (CI -10.5 to -1.5, P = .009), whereas infection was associated with a 6.3-point decrease in IQ (CI -12.3 to -0.3, P = .04), after adjusting for gestational age and white matter injury volume. BPD was associated with left hemisphere-dominant FA reductions, which were associated with worse motor (P = .000006) and visual-motor (P = .00005) outcomes, whereas infection was associated with bilateral FA reductions, which were associated with lower IQ scores (P = .03) and poorer working memory (P = .01) at 8 years.
Conclusions:
This cohort study of children born very preterm suggests that BPD and culture-positive infection are distinctly associated with impaired white-matter development and poor neurodevelopmental outcomes. These findings imply neonatal illnesses impact the brain nonuniformly, suggesting opportunities for targeted intervention.
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