Neonatal Critical Illness, 8-Year White Matter Microstructure, and Motor Function in Children Born Very Preterm

Area of Science:

• Neuroscience
• Developmental Pediatrics
• Neonatology

Background:

• Preterm birth is associated with neurodevelopmental challenges.
• Neonatal critical illness can negatively affect brain development.
• Long-term outcomes of neonatal critical illness in preterm infants require further investigation.

Purpose of the Study:

• To examine the relationship between neonatal critical illness severity in preterm infants and white matter maturation at 8 years of age.
• To assess the association between neonatal critical illness, white matter maturation, and motor and visual-motor integration performance at school age.

Main Methods:

• Prospective longitudinal study of 234 preterm neonates (24-32 weeks gestational age).
• Neonatal critical illness was defined by specific conditions (e.g., infection, BPD, IVH, WMI).
• At 8 years, children underwent motor and visual-motor integration assessments, and diffusion tensor imaging (DTI) for white matter maturation (fractional anisotropy).

Main Results:

• Higher neonatal critical illness counts (≥3) were linked to significant decreases in motor and visual-motor integration (VMI) scores at age 8.
• Increased neonatal critical illness was associated with reduced white matter fractional anisotropy in the corpus callosum and motor pathways.
• Motor and VMI scores were correlated with white matter microstructure integrity.

Conclusions:

• Cumulative critical illness during the neonatal period in preterm infants is associated with lasting alterations in white matter microstructure and maturation.
• These white matter changes are demonstrably related to impaired motor and visual-motor performance in school-aged children.
• Findings underscore the importance of neonatal intensive care unit exposures and the necessity for continued school-age follow-up for preterm infants.