Associations Between Neonatal Brain Structure, the Home Environment, and Childhood Outcomes Following Very Preterm Birth

Abstract

Background Very preterm birth is associated with an increased risk of childhood psychopathology and cognitive deficits. However, the extent to which these developmental problems associated with preterm birth are amenable to environmental factors or determined by neurobiology at birth remains unclear. Methods We derived neonatal brain structural covariance networks using non-negative matrix factorization in 384 very preterm infants (median gestational age [range], 30.29 [23.57–32.86] weeks) who underwent magnetic resonance imaging at term-equivalent age (median postmenstrual age, 42.57 [37.86–44.86] weeks). Principal component analysis was performed on 32 behavioral and cognitive measures assessed at preschool age ( n = 206; median age, 4.65 [4.19–7.17] years) to identify components of childhood psychopathology and cognition. The Cognitively Stimulating Parenting Scale assessed the level of cognitively stimulating experiences available to the child at home. Results Cognitively stimulating parenting was associated with reduced expression of a component reflecting developmental psychopathology and executive dysfunction consistent with the preterm phenotype (inattention-hyperactivity, autism spectrum behaviors, and lower executive function scores). In contrast, a component reflecting better general cognitive abilities was associated with larger neonatal gray matter volume in regions centered on key nodes of the salience network, but not with cognitively stimulating parenting. Conclusions Our results suggest that while neonatal brain structure likely influences cognitive abilities in very preterm children, the severity of behavioral symptoms that are typically observed in these children is sensitive to a cognitively stimulating home environment. Very preterm children may derive meaningful mental health benefits from access to cognitively stimulating experiences during childhood.

Longitudinal neonatal brain development and socio-demographic correlates of infant outcomes following preterm birth

“…In contrast, along PC2, better psychomotor performance covaries with subthreshold increased, rather than decreased, psychopathology (thus possibly reflecting more “pure” psychomotor functioning). This pattern is largely consistent with our previous observations in an independent cohort of slightly older very preterm born children (Vanes et al, 2021). Including the two components jointly in subsequent analyses allowed us to assess the neural and socio-demographic correlates of one while controlling for the other.…”

“…All variables were scaled to a mean of 0 and unit variance before PCA was performed. A permutation testing procedure was used to identify significant components, as described in more detail elsewhere (Vanes et al, 2021). To assess meaningful contribution of individual variables to the identified PCs, we defined the loading threshold as , equivalent to the loading value if all 10 variables included in the PCA loaded equally onto the same component.…”

“…Overall, the developmental consequences of preterm birth vary widely, yet the early predictors and moderators of behavioural outcomes remain poorly understood. Alterations in brain development as a result of premature exposure of the brain to the extrauterine environment during a critical period of neural growth is thought to play a substantial role in conferring risk for developmental problems (Ment et al, 2009); however, it is also clear that the environment can have a significant impact on behavioural development in this vulnerable population (Neel et al, 2018; Vanes et al, 2021; Wong and Edwards, 2013).…”

The Signature of Moderate Perinatal Hypoxia on Cortical Organization and Behavior: Altered PNN-Parvalbumin Interneuron Connectivity of the Cingulate Circuitries

“…Perinatal cerebral hypoxia-ischemia and preterm birth are the most common causes of neurological disorders or impaired brain function of developmental origin ( Volpe, 2012 ; Vohr, 2014 ; Laptook, 2016 ; Vanes et al, 2021 ). Although current advances in medicine provide good perinatal care, 30% of premature babies who survive still suffer from neurodevelopmental motor, cognitive, or behavioral deficits in childhood or later in life ( Johnson, 2011 ; Franz et al, 2018 ).…”

Parental Practices and Environmental Differences among Infants Living in Upper-Middle and High-Income Countries: A Cross-Sectional Study

“…Preterm infants, even in high-income countries, are exposed to an increased risk of adverse neonatal outcomes and long-term neurodevelopmental and behavioral sequelae, lower cognitive functioning, and ongoing respiratory and other morbidities [ 30 ]. However, a suitable home environment shows benefits in cognitive ability, even for very preterm infants [ 31 ].…”