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Mapping white matter microstructure at term age to motor outcomes at 2 years in very preterm infants: a multicentre
Ankita Joshi1, Wei Jia1, Junqi Wang1
1Artificial Intelligence Imaging Research Center, Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Insights
Very preterm infants who develop motor impairments show altered white matter connectivity. These differences in fractional anisotropy (FA) suggest early issues in visual-motor, sensorimotor, and thalamo-cortical pathways.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Medical Imaging
Background:
- Very preterm (VPT) infants are at high risk for neurodevelopmental disorders.
- Motor impairment is a common outcome in VPT infants, impacting long-term development.
- Understanding white matter microstructure differences is crucial for early identification and intervention.
Purpose of the Study:
- To characterize white matter microstructural differences in VPT infants who develop motor impairment by age 2 years.
- To investigate the relationship between white matter integrity and motor outcomes in VPT infants.
Main Methods:
- Cohort study of VPT infants (<33 weeks gestational age) recruited from neonatal intensive care units.
- MRI at term-equivalent age to assess white matter microstructure using fractional anisotropy (FA).
- Motor performance assessed at 2 years corrected age using the Bayley Scales of Infant and Toddler Development, III (Bayley-III). Motor impairment defined as Bayley-III score <85.
Main Results:
- 84 infants with motor impairment and 247 controls were analyzed.
- Infants with motor impairment exhibited significantly lower FA in sensorimotor and non-sensorimotor tracts compared to controls.
- A positive association between FA and Bayley scores was observed in sensorimotor and non-sensorimotor tracts in the impaired group, but not in controls.
Conclusions:
- VPT infants who develop motor impairments demonstrate altered inter- and intrahemispheric white matter connectivity.
- Early signs of impaired visual-motor, sensorimotor, and thalamo-cortical connectivity are evident.
- These microstructural alterations extend beyond traditionally defined sensorimotor pathways.
Objective:
To characterise white matter microstructural differences within very preterm (VPT; <33 weeks' gestational age) infants that develop motor impairment in the first 2 years of life.
Design:
Cohort study, VPT infants (Cincinnati Infant Neurodevelopment Early Prediction Study) recruited from five level III/IV neonatal intensive care units in the greater Cincinnati area between September 2016 and November 2019.
Setting:
Multicentre study; participants received MRI at term-equivalent age at Cincinnati Children's Hospital Medical Center and were followed-up at 2 years corrected age to assess their motor performance.
Patients:
Infants born before 33 weeks were eligible.
Main Outcomes And Measures:
Composite motor scores at 2 years corrected age (CA) on the Bayley Scales of Infant and Toddler Development, III. Fractional anisotropy (FA) along the white matter tracts was used to measure white matter microstructure. Motor impairment was defined as Bayley-III motor score <85.
Results:
247 controls and 84 impaired infants were included in the study. Compared with the controls, infants with motor impairment were characterised by location-dependent credible group differences and significantly lower FA in both sensorimotor and non-sensorimotor tracts. A location-specific significant positive association between FA and Bayley scores in the impaired group was observed in multiple sensorimotor tracts and non-sensorimotor tracts. No significant associations were found between FA and Bayley scores in the controls.
Conclusion:
VPT infants developing motor impairments show altered inter and intrahemispheric connectivity, with early indications of impaired visual-motor, sensorimotor and thalamo-cortical connectivity, extending beyond sensorimotor tracts.
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