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Neonatal Critical Illness, 8-Year White Matter Microstructure, and Motor Function in Children Born Very Preterm
Sarvenaz Oloomi1, Steven Ufkes2, Thiviya Selvanathan3
1Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC, Canada; Psychology, University of Southern California, Los Angeles, CA.
Insights
Neonatal critical illness in preterm infants impacts long-term white matter maturation, motor skills, and visual-motor integration at school age. Early intensive care and follow-up are crucial for these vulnerable children.
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.
Objective:
To assess relationships between neonatal critical illness in children born preterm with white matter maturation and clinical motor and visual-motor integration (VMI) performance at 8 years.
Study Design:
Prospective longitudinal study of 234 neonates (24-32 weeks gestational age [GA]) recruited from 2006 to 2013 at a tertiary neonatal intensive care unit. Neonatal critical illness included infection, bronchopulmonary dysplasia, retinopathy of prematurity, severe intraventricular hemorrhage, and significant white matter injury. At age 8 years, children completed visual-motor (Beery-Buktenica Developmental Test of Visual-Motor Integration, sixth edition) and motor (Movement Assessment Battery for Children, second edition) assessments. Tract-based spatial statistics were used to analyze fractional anisotropy from diffusion tensor imaging acquired at 8 years to measure white matter maturation.
Results:
Of 226 survivors, 129 children (69 males [53%]) were assessed at 8 years and had high-quality diffusion tensor imaging. Neonatal critical illness counts ≥ 3 were associated with 11.8-point decrease in motor (CI -23-(-.55), P = .04) and 11.3-point decrease in VMI scores (CI -18.2-(-4.5), P = .001), accounting for GA and maternal education. Higher neonatal critical illness counts (P = .04) and lower motor (P < .001) and VMI (P = .04) scores were related to bilateral reductions in white matter fractional anisotropy in the corpus callosum and motor association pathways, accounting for GA, neonatal brain injury, maternal education, and age at scan.
Conclusions:
Cumulative critical illness in neonates born preterm is associated with long-term changes in white matter microstructure and maturation, which are related to motor and visual motor performance at school-age. These findings highlight the long-term importance of neonatal intensive care exposures and need for school-age follow-up of children born preterm.
