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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Association between neonatal brain volume and school-age executive function in children born moderate-to-late preterm
Lauren Rossetti1,2, Leona Pascoe3,4,5, Rheanna M Mainzer5,6
1School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia. laurenrossetti1@gmail.com.
Insights
Neonatal brain volumes in moderate-to-late preterm (MLP) children show weak links to school-age executive function (EF). Further research is needed to identify other predictors of EF in this understudied population.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Medical Imaging
Background:
- Larger neonatal brain volumes correlate with better cognitive development in moderate-to-late preterm (MLP) infants.
- The persistence of this association into school-age executive function (EF) remains largely unexplored in MLP populations.
Purpose of the Study:
- To investigate the association between neonatal brain volumes and executive function (EF) at 9 years of age in children born moderate-to-late preterm (MLP).
- To determine if neonatal brain structure predicts school-age EF outcomes in this specific preterm group.
Main Methods:
- Brain magnetic resonance imaging (MRI) was performed at term-equivalent age in 168 MLP infants.
- Executive function (EF) was assessed at 9 years in 159 children using measures of attentional control, cognitive flexibility, goal setting, and behavioral EF.
- Linear regression models estimated associations between brain volumes and EF subdomains, with analyses stratified by subgroups.
Main Results:
- Few significant associations were observed between neonatal brain volumes and school-age EF.
- Small positive associations were found between larger white matter volume and improved goal setting (p=0.01).
- Subgroup analyses yielded similar, limited associations.
Conclusions:
- Neonatal brain volumes are not strong predictors of school-age executive function (EF) in children born moderate-to-late preterm (MLP).
- Findings contrast with previous studies in very preterm infants, suggesting unique developmental trajectories.
- Future research should focus on more sensitive neuroimaging techniques and other risk factors impacting EF in MLP children.
Background:
Larger brain volumes in the neonatal period are associated with better 2-year cognitive development in children born moderate-to-late preterm (MLP). Whether these associations persist into school age for executive function (EF) is unknown.
Methods:
Children born MLP underwent brain magnetic resonance imaging (MRI) at term-equivalent age (n = 168) and EF assessment at 9 years (n = 159). Mean or median differences in EF subdomains (attentional control, cognitive flexibility, goal setting, behavioral EF) for a unit increase in brain volumes were estimated using linear regression, overall and for subgroups defined by gestational age at MRI, sex and excluding participants with developmental delay at 2 years.
Results:
There were few associations between brain volumes and EF. Small effects were found for larger total tissue (mean difference = 0.16; 95% CI = -0.04, 0.36; p = 0.11), white matter (mean difference = 0.21; 95% CI = 0.05, 0.38; p = 0.01) and subcortical gray matter (mean difference = 0.17; 95% CI = -0.01, 0.34; p = 0.06) volumes and improved goal setting. Subgroup relationships were similar.
Conclusion:
Neonatal brain volumes in MLP children are not strongly associated with school-age EF. Imaging techniques with higher sensitivity, and other risk factors for poorer EF should be explored.
Impact:
This study described the associations between neonatal brain volumes and executive function (EF) outcomes at 9 years in children born moderate-to-late preterm (MLP), a group that has been under researched compared with children born very preterm. There was limited evidence of an association between neonatal brain volumes and school-age EF outcomes in children born MLP, contrasting previous findings in very preterm children. This suggests that neonatal brain volumes alone do not effectively predict school-age EF in children born MLP, highlighting the need for more sensitive neuroimaging techniques and identification of other important predictors of long-term outcomes in this population.
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