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Neonatal motor functional connectivity and motor outcomes at age two years in very preterm children with and without high-grade brain injury.

ABSTRACT: Preterm-born children have high rates of motor impairments, but mechanisms for early identification remain limited. We hypothesized that neonatal motor system functional connectivity (FC) would relate to motor outcomes at age two years; currently, this relationship is not yet well-described in very preterm (VPT; born <32 weeks' gestation) infants with and without brain injury. We recruited 107 VPT infants - including 55 with brain injury (grade III-IV intraventricular hemorrhage, cystic periventricular leukomalacia, post-hemorrhagic hydrocephalus) - and collected FC data at/near term-equivalent age (35-45 weeks postmenstrual age). Correlation coefficients were used to calculate the FC between bilateral motor and visual cortices and thalami. At two years corrected-age, motor outcomes were assessed with the Bayley Scales of Infant and Toddler Development, 3rd edition. Multiple imputation was used to estimate missing data, and regression models related FC measures to motor outcomes. Within the brain-injured group only, interhemispheric motor cortex FC was positively related to gross motor outcomes. Thalamocortical and visual FC were not related to motor scores. This suggests neonatal alterations in motor system FC may provide prognostic information about impairments in children with brain injury.

SUBMITTER: Cyr PEP

PROVIDER: S-EPMC9668638 | biostudies-literature | 2022 Nov

REPOSITORIES: biostudies-literature

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Neonatal motor functional connectivity and motor outcomes at age two years in very preterm children with and without high-grade brain injury.

Cyr Peppar E P PEP Lean Rachel E RE Kenley Jeanette K JK Kaplan Sydney S Meyer Dominique E DE Neil Jeffery J JJ Alexopoulos Dimitrios D Brady Rebecca G RG Shimony Joshua S JS Rodebaugh Thomas L TL Rogers Cynthia E CE Smyser Christopher D CD

NeuroImage. Clinical 20221109

Preterm-born children have high rates of motor impairments, but mechanisms for early identification remain limited. We hypothesized that neonatal motor system functional connectivity (FC) would relate to motor outcomes at age two years; currently, this relationship is not yet well-described in very preterm (VPT; born <32 weeks' gestation) infants with and without brain injury. We recruited 107 VPT infants - including 55 with brain injury (grade III-IV intraventricular hemorrhage, cystic perivent ...[more]

PMID: 36451363

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Project description:ImportanceNeonatal protein intake following very preterm birth has long lasting effects on brain development. However, it is uncertain whether these effects are associated with improved or impaired brain maturation.ObjectiveTo assess the association of neonatal protein intake following very preterm birth with brain structure at 7 years of age.Design, setting, and participantsThis cohort study involved children born very preterm before or after a change in neonatal intensive care unit nutritional protocol that increased protein intake at the National Women's Hospital in Auckland, New Zealand. The children completed magnetic resonance imaging (MRI) scanning at 7 years. There were 128 children who were initially eligible. MRI data were ineligible for analysis if excessive head motion or clinical brain abnormalities were present. Data were collected from July 2012 to January 2016, and data analysis took place from January 2017 to March 2024.ExposureNeonatal intensive care unit nutritional protocol. Those who were born before the protocol change took place (July 2005 to December 2006) were in the old protocol group, while those who were born after the protocol change (January 2007 to October 2008) were in the new protocol group. Observers were blind to participant grouping.Main outcomes and measuresAll actual enteral and parenteral intakes of protein, fat, energy, and breast milk for days 1 to 7 and days 1 to 14, and growth velocity to postnatal day 28 were calculated for each infant. Preplanned outcomes were group comparisons between regional brain volumes and diffusion parameters of major white matter tracts along with analyses with both groups combined exploring associations of nutrition with brain metrics.ResultsData from 99 children were analyzed, including 42 in the old protocol group (26 female [55%]; mean [SD] gestational age at birth, 27 [2] weeks) and 57 in the new protocol group (27 female [47%]; mean [SD] gestational age at birth, 26 [2] weeks). Protein intake differed between the groups at both 7 days (old protocol: mean [SD] intake, 17 [2] g/kg-1; new protocol: mean [SD] intake, 21 [2] g/kg-1) and 14 days after birth (old protocol: mean [SD] intake, 41 [6] g/kg-1; new protocol: mean [SD] intake, 45 [7] g/kg-1). The new protocol group had smaller brain volume as a percentage of intercranial volume than the old protocol group (mean [SD], 80% [4%] vs 86% [7%]) but absolute brain volumes were similar. The new protocol group had significantly thinner lateral occipital and lateral parietal cortices than the old protocol group. With both groups combined, those with greater protein, fat, energy, and breast milk intake had more mature diffusion tensor metrics (higher fractional anisotropy and less diffusion) across multiple tracts, although this finding did not reach statistical significance for every tract.Conclusions and relevanceIn this cohort of children born very preterm, children with greater neonatal protein intake had a more mature profile of brain metrics assessed with MRI at 7 years of age. These results contribute to the ongoing evaluation of optimal nutrition for infants born very preterm and suggest that the protein intake experienced by the new protocol group may promote brain maturation in a way that is still observable at 7 years of age.

Project description:Very low birth weight preterm (PT) children are at high risk for brain injury. Employing diffusion tensor imaging (DTI), we tested the hypothesis that PT adolescents would demonstrate microstructural white matter disorganization relative to term controls at 16 years of age. Forty-four PT subjects (600-1250 g birth weight) without neonatal brain injury and 41 term controls were evaluated at age 16 years with DTI, the Wechsler Intelligence Scale for Children-III (WISC), the Peabody Picture Vocabulary Test-Revised (PPVT), and the Comprehensive Test of Phonological Processing (CTOPP). PT subjects scored lower than term subjects on WISC full scale (p=0.003), verbal (p=0.043), and performance IQ tests (p=0.001), as well as CTOPP phonological awareness (p=0.004), but scored comparably to term subjects on PPVT and CTOPP Rapid Naming tests. PT subjects had lower fractional anisotropy (FA) values in multiple regions including bilateral uncinate fasciculi (left: p=0.01; right: p=0.004), bilateral external capsules (left: p<0.001; right: p<0.001), the splenium of the corpus callosum (p=0.008), and white matter serving the inferior frontal gyrus bilaterally (left: p<0.001; right: p=0.011). FA values in both the left and right uncinate fasciculi correlated with PPVT scores (a semantic language task) in the PT subjects (left: r=0.314, p=0.038; right: r=0.336, p=0.026). FA values in the left and right arcuate fasciculi correlated with CTOPP Rapid Naming scores (a phonologic task) in the PT subjects (left: r=0.424, p=0.004; right: r=0.301, p=0.047). These data support for the first time that dual pathways underlying language function are present in PT adolescents. The striking bilateral dorsal correlations for the PT group suggest that prematurely born subjects rely more heavily on the right hemisphere than typically developing adults for performance of phonological language tasks. These findings may represent either a delay in maturation or the engagement of alternative neural pathways for language in the developing PT brain.

Dataset Information

Neonatal motor functional connectivity and motor outcomes at age two years in very preterm children with and without high-grade brain injury.

Publications

Neonatal motor functional connectivity and motor outcomes at age two years in very preterm children with and without high-grade brain injury.

Similar Datasets

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