Neonatal brain pathology predicts adverse attention and processing speed outcomes in very preterm and/or very low birth weight children.

Abstract

Objective This study aimed to examine attention and processing speed outcomes in very preterm (VPT; <32 weeks' gestational age) or very low birth weight (VLBW; <1500 g) children, and to assess the ability of brain abnormalities measured by neonatal magnetic resonance imaging (MRI) to predict outcome in these domains. Methods A cohort of 198 children born <30 weeks' gestational age and/or <1250 g and 70 term controls were examined. Neonatal MRI scans at term equivalent age were quantitatively assessed for white matter, cortical gray matter, deep gray matter, and cerebellar abnormalities. Attention and processing speed were assessed at 7 years using standardized neuropsychological tests. Group differences were tested in attention and processing speed, and the relationships between these cognitive domains and brain abnormalities at birth were investigated. Results At 7 years of age, the VPT/VLBW group performed significantly poorer than term controls on all attention and processing speed outcomes. Associations between adverse attention and processing speed performances at 7 years and higher neonatal brain abnormality scores were found; in particular, white matter and deep gray matter abnormalities were reasonable predictors of long-term cognitive outcomes. Conclusion Attention and processing speed are significant areas of concern in VPT/VLBW children. This is the first study to show that adverse attention and processing speed outcomes at 7 years are associated with neonatal brain pathology.

Validation of an MRI Brain Injury and Growth Scoring System in Very Preterm Infants Scanned at 29- to 35-Week Postmenstrual Age

“…The scoring system on which this study was based has been used in 2 studies examining the relationships between TEA MR imaging and cognitive outcomes at 7 years. 24,25 Our results support previous findings at TEA and suggest that the brain changes associated with adverse cognitive outcomes are already present as early as 29 to 35 weeks PMA. 7 Of all MR imaging subscale scores, at early and term MR imaging, DGM demonstrated the strongest relationship with outcome.…”

“…22 At TEA, global brain abnormality scores were significantly associated with motor outcomes at 2-years CA 23 ; and cognitive outcomes, at 7 years. 24,25 Deep gray matter scores were significantly associated with poorer attention and processing speeds, memory, and learning. 24,25 With safe earlier MR imaging now possible with MR compatible incubators, valid scoring systems for use earlier than TEA are required.…”

“…24,25 Deep gray matter scores were significantly associated with poorer attention and processing speeds, memory, and learning. 24,25 With safe earlier MR imaging now possible with MR compatible incubators, valid scoring systems for use earlier than TEA are required. The aim of this study was to validate an MR imaging scoring system previously developed for very preterm infants at TEA in a cohort of infants born Ͻ31-weeks gestational age with MR imaging between 29 and 35 weeks' postmenstrual age (PMA).…”

Commentary on “Kindergarten classroom functioning of extremely preterm/extremely low birth weight children” or “Leaving no child behind: Promoting educational success for preterm survivors”

“…Proactive school entry attention and executive function supports directed at children with the high biomedical, social or developmental risk thus have the potential to optimize early school learning trajectories. Advances in functional neuroimaging have revealed that this vulnerability can be lessened by proactive evidence based interventions [20,21]. In this way we can then ensure that all vulnerable preterm children who enter kindergarten have the health and developmental supports that optimize learning and school success.…”

Cognitive performance of premature infants: association between bronchopulmonary dysplasia and cognitive skills. Cross-sectional study

“…It is important to identify early problems within each of these elementary skills, so as to intervene and potentially limit more generalized cognitive deficits. 5 In Brazil, follow-up studies on children born prematurely have been conducted. [6][7][8][9][10][11] However, little information on outcomes from children with neonatal morbidity is available, including on its repercussions on cognitive development and its associations with less favorable socioeconomic and care conditions.…”