Association of Early-Life or Term-Equivalent White Matter Injury With Neurodevelopmental Outcomes in Very Preterm...

Area of Science:

• Neonatal neuroscience
• Developmental pediatrics
• Neuroimaging

Background:

• Very preterm infants are at high risk for white matter injury (WMI).
• Neurodevelopmental outcomes are significantly impacted by WMI.
• Assessing WMI at different time points may yield different prognostic information.

Purpose of the Study:

• To determine if white matter injury (WMI) severity and location on early-life vs. term-equivalent age (TEA) brain MRI are associated with 36-month neurodevelopment.
• To compare the predictive value of WMI assessment at two distinct time points in very preterm infants.

Main Methods:

• Recruited very preterm infants from 3 tertiary NICUs, performing early-life and TEA MRI scans.
• Scored moderate-severe WMI and anterior/posterior location; assessed neurodevelopment at 36 months using Bayley Scales (delay <85 composite score).
• Utilized multivariable logistic regressions, adjusting for key clinical factors, to analyze WMI associations with neurodevelopment.

Main Results:

• Moderate-severe WMI and anterior WMI on early-life MRI were associated with cognitive delay (OR 3.82 and 5.47, respectively).
• Early-life anterior WMI was also linked to motor delay (OR 3.02).
• These associations between WMI and neurodevelopmental delay were not significant at term-equivalent age (TEA).

Conclusions:

• Moderate-severe and anterior WMI identified on early-life MRI are associated with adverse neurodevelopmental outcomes at 36 months.
• Term-equivalent age (TEA) MRI did not show similar associations, suggesting early-life assessment is more critical.
• Early-life MRI may be a more optimal time point for evaluating WMI and predicting neurodevelopmental trajectories in very preterm infants.