Disruption to functional networks in neonates with perinatal brain injury predicts motor skills at 8 months

Abstract

ObjectiveFunctional connectivity magnetic resonance imaging (fcMRI) of neonates with perinatal brain injury could improve prediction of motor impairment before symptoms manifest, and establish how early brain organization relates to subsequent development. Methods: This cohort study is the first to describe and quantitatively assess functional brain networks and their relation to later motor skills in neonates with a diverse range of perinatal brain injuries. Infants (n=65, included in final analyses: n=53) were recruited from the neonatal intensive care unit (NICU) and were stratified based on their age at birth (premature vs. term), and on whether neuropathology was diagnosed from structural MRI. Functional brain networks and a measure of disruption to functional connectivity were obtained from 14 minutes of fcMRI acquired during natural sleep at term-equivalent age.ResultsDisruption to connectivity of the somatomotor and frontoparietal executive networks predicted motor impairment at 4 and 8 months. This disruption in functional connectivity was not found to be driven by differences between clinical groups, or by any of the specific measures we captured to describe the clinical course.ConclusionfcMRI was predictive over and above other clinical measures available at discharge from the NICU, including structural MRI. Motor learning was affected by disruption to somatomotor networks, but also frontoparietal executive networks, which supports the functional importance of these networks in early development. Disruption to these two networks might be best addressed by distinct intervention strategies.

Typical and disrupted brain circuitry for conscious awareness in full-term and preterm infants

“…By contrast, this relationship is not present in preterm neonates before term-equivalent age. Our results in full-term neonates are consistent with a number of previous studies that observed high-order networks in this group (Rajasilta et al, 2020;Linke et al, 2018;He et al, 2016He et al, , 2015Doria et al, 2010)…”

“…He et al (2015) detected a fronto-parietal network, comprising the frontal gyrus and inferior parietal cortex, and a second one, comprising the anterior cingulate cortex, medial prefrontal cortex, superior/middle frontal gyrus, in preterm neonates. Linke et al (2018) found that both the ECN and DMN were present even in neonates with perinatal brain injuries, both full-term and preterm neonates scanned at TEA. Several factors may contribute to these divergent results.…”

“…Although some previous studies have observed high-order networks in neonates (Rajasilta et al, 2020;Linke et al, 2018;He et al, 2015He et al, , 2016Doria et al, 2010) others have not (Gao et al, 2015a(Gao et al, , 2015bFransson et al, 2007;Eyre et al, 2020). This inconsistency is likely due to methodological differences in the type of data acquired and the analyses method.…”

“…A similar pattern was also reported for the DAN and ECN (Gao et al, 2015b;Fransson et al, 2009). By contrast, other rs-fMRI studies (Linke et al, 2018;He et al, 2015He et al, , 2016Doria et al, 2010) support the idea that these networks have already emerged in neonates. For instance, Doria et al (2010) found that both primary and high-order networks were present in full-term and preterm neonates scanned at term-equivalent age (TEA: 37 -42 weeks of postmenstrual age).…”

Evidence of hippocampal learning in human infants

“…Evidence for frontal involvement in this task is broadly consistent with recent research suggesting that the frontal cortex plays an important role in infant cognition. [45][46][47] An important limitation of the current study is the inability of fMRI to distinguish whether evidence of statistical learning in the hippocampus originates in the hippocampus or is a reflection of processing in the mPFC, given their connectivity.…”