Background

Relative to full-term infants, very preterm infants exhibit disrupted white matter (WM) maturation and problems related to development, including motor, cognitive, social-emotional, and receptive and expressive language processing.

Objective

The present study aimed to determine whether regional abnormalities in the WM microstructure of very preterm infants, as defined relative to those of full-term infants at a near-term age, are associated with neurodevelopmental outcomes at the age of 18–22 months.

Methods

We prospectively enrolled 89 very preterm infants (birth weight < 1500 g) and 43 normal full-term control infants born between 2016 and 2018. All infants underwent a structural brain magnetic resonance imaging scan at near-term age. The diffusion tensor imaging (DTI) metrics of the whole-brain WM tracts were extracted based on the neonatal probabilistic WM pathway. The elastic net logistic regression model was used to identify altered WM tracts in the preterm brain. We evaluated the associations between the altered WM microstructure at near-term age and motor, cognitive, social-emotional, and receptive and expressive language developments at 18–22 months of age, as measured using the Bayley Scales of Infant Development, Third Edition.

Results

We found that the elastic net logistic regression model could classify preterm and full-term neonates with an accuracy of 87.9% (corrected p < 0.008) using the DTI metrics in the pathway of interest with a 10% threshold level. The fractional anisotropy (FA) values of the body and splenium of the corpus callosum, middle cerebellar peduncle, left and right uncinate fasciculi, and right portion of the pathway between the premotor and primary motor cortices (premotor-PMC), as well as the mean axial diffusivity (AD) values of the left cingulum, were identified as contributive features for classification. Increased adjusted AD values in the left cingulum pathway were significantly correlated with language scores after false discovery rate (FDR) correction (r = 0.217, p = 0.043). The expressive language and social-emotional composite scores showed a significant positive correlation with the AD values in the left cingulum pathway (r = 0.226 [p = 0.036] and r = 0.31 [p = 0.003], respectively) after FDR correction.

Conclusion

Our approach suggests that the cingulum pathways of very preterm infants differ from those of full-term infants and significantly contribute to the prediction of the subsequent development of the language and social-emotional domains. This finding could improve our understanding of how specific neural substrates influence neurodevelopment at later ages, and individual risk prediction, thus helping to inform early intervention strategies that address developmental delay.

中文翻译：

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早产儿的扣带与足月等效年龄的2岁时的语言和社会情感障碍有关

背景

相对于足月婴儿，极早产婴儿会出现白质（WM）破裂和与发育有关的问题，包括运动，认知，社交情感以及接受和表达语言的处理。

目的

本研究旨在确定早产儿相对于足月儿足月儿的WM显微结构的区域异常是否与18-22个月大的神经发育结果相关。

方法

我们前瞻性纳入了2016年至2018年之间出生的89名极早产婴儿（出生体重<1500 g）和43名正常的足月对照婴儿。所有婴儿均在近期年龄进行了结构性脑磁共振成像扫描。基于新生儿概率WM路径提取全脑WM道的弥散张量成像（DTI）指标。弹性净逻辑回归模型用于识别早产儿大脑中WM道的改变。我们使用Bayley婴儿发育量表（第三版）评估了在近期年龄改变的WM微观结构与18-22个月大的运动，认知，社交情感以及接受和表达语言发展之间的关联。

结果

我们发现，弹性净逻辑回归模型可以使用感兴趣路径中10％阈值水平的DTI指标对早产和足月新生儿进行分类，准确性为87.9％（校正后的p <0.008）。call体，脾小body的身体和脾脏，小脑中枢小花梗，左和右钩状筋膜，运动前皮层和初级运动皮层（premotor-PMC）之间的通路的右侧部分的分数各向异性（FA）值左扣带的平均轴向扩散率（AD）值被确定为分类的重要特征。假发现率（FDR）校正后，左扣带途径中调整后的AD值增加与语言评分显着相关（r = 0.217，p = 0.043）。

结论

我们的方法表明，早产儿的扣带途径与足月儿的扣带途径不同，并且对语言和社会情感领域的后续发展做出了重要贡献。这一发现可以增进我们对特定神经基质在晚年如何影响神经发育以及个体风险预测的理解，从而有助于为解决发育迟缓的早期干预策略提供信息。