Visual alertness and brain diffusion tensor imaging at term age predict neurocognitive development at preschool age in extremely preterm‐born children

Abstract

Introduction:Cognitive development is characterized by the structural and functional maturation of the brain. Diffusion-weighted magnetic resonance imaging (dMRI) provides methods of investigating the brain structure and connectivity and their correlations with the neurocognitive outcome. Our aim was to examine the relationship between early visual abilities, brain white matter structures, and the later neurocognitive outcome. Methods:This study included 20 infants who were born before 28 gestational weeks and followed until the age of 6.5 years. At term age, visual alertness was evaluated and dMRI was used to investigate the brain white matter structure using fractional anisotropy (FA) in tract-based spatial statistics analysis. The JHU DTI white matter atlas was used to locate the findings. The neuropsychological assessment was used to assess neurocognitive performance at 6.5 years. Results:Optimal visual alertness at term age was significantly associated with better visuospatial processing (p < .05), sensorimotor functioning (p < .05), and social perception (p < .05) at 6.5 years of age. Optimal visual alertness related to higher FA values, and further, the FA values positively correlated with the neurocognitive outcome. The tract-based spatial differences in FA values were detected between children with optimal and nonoptimal visual alertness according to performance at 6.5 years. Conclusion:We provide neurobiological evidence for the global and tract-based spatial differences in the white matter maturation between extremely preterm children with optimal and nonoptimal visual alertness at term age and a link between white matter maturation, visual alertness and the neurocognitive outcome at 6.5 years proposing that early visual function is a building block for the later neurocognitive development.

Correlation between Early Visual Functions and Cognitive Outcome in Infants at Risk for Cerebral Palsy or Other Neurodevelopmental Disorders: A Systematic Review

“…A total of 2548 studies were retrieved through the search. Eight studies met all inclusion criteria [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. The studies included a total of 532 infant participants with newborn-detectable-risk for neurodevelopment, of which 503 were born preterm and 29 were born at term.…”

“…The timing of the initial vision function assessment was variable from term equivalent age to 5 months, apart from one study that evaluated 8 out of 26 infants between 6- and 11-months corrected age. The early visual function assessments reported in the studies included assessment batteries or single assessment items: visual alertness [ 20 , 22 ] and visual orientation [ 22 ] on the HNNE [ 14 ], nine unspecified items on the Neonatal Assessment of Visual Function Ricci Scale [ 12 ]; visual tracking through electro-oculography [ 25 , 26 ]; fixation shift and a set combining the visual field (kinetic perimetry), fixation, following, eye movement and visual attention on the Atkinson Battery of Child Development for Examining Functional Vision ABCDEFV [ 24 , 27 ]; and horizontal fixation and following on the Einstein Neonatal Neurobehavioral Assessment Scale ENNAS (Wallace) [ 23 ].…”

“…Neonatal assessments of vision mainly targeted visual alertness, as expressed by the ability to fixate and maintain fixation on an object, and visual orientation in terms of the ability to follow a moving target. In three of the four papers assessing neonatal behavior, visual functions were addressed by one or two items of a more comprehensive neurological test, exploring the ability to fixate and or follow a target [ 20 , 22 , 23 ]. In the remaining one a nine-item scale was used, in which, however, responses were always based on the same two abilities [ 21 ].…”