Neonatal brain microstructure correlates of neurodevelopment and gait in preterm children 18–22 mo of age: an MRI and DTI study

Abstract

Background: Near-term brain structure was examined in preterm infants in relation to neurodevelopment. We hypothesized that near-term macrostructural brain abnormalities identified using conventional magnetic resonance imaging (MRI), and white matter (WM) microstructure detected using diffusion tensor imaging (DTI), would correlate with lower cognitive and motor development and slower, less-stable gait at 18-22 mo of age. Methods: One hundred and two very-low-birth-weight preterm infants (≤1,500 g birth weight; ≤32 wk gestational age) were recruited prior to routine near-term brain MRI at 36.6 ± 1.8 wk postmenstrual age. Cerebellar and WM macrostructure was assessed on conventional structural MRI. DTI was obtained in 66 out of 102 and WM microstructure was assessed using fractional anisotropy and mean diffusivity (MD) in six subcortical brain regions defined by DiffeoMap neonatal atlas. Neurodevelopment was assessed with Bayley-Scales-of-InfantToddler-Development, 3rd-Edition (BSID-III); gait was assessed using an instrumented mat. results: Neonates with cerebellar abnormalities identified using MRI demonstrated lower mean BSID-III cognitive composite scores (89.0 ± 10.1 vs. 97.8 ± 12.4; P = 0.002) at 18-22 mo. Neonates with higher DTI-derived left posterior limb of internal capsule (PLIC) MD demonstrated lower cognitive and motor composite scores (r = −0.368; P = 0.004; r = −0.354; P = 0.006) at 18-22 mo; neonates with higher genu MD demonstrated slower gait velocity (r = −0.374; P = 0.007). Multivariate linear regression significantly predicted cognitive (adjusted r 2 = 0.247; P = 0.002) and motor score (adjusted r 2 = 0.131; P = 0.017). conclusion: Near-term cerebellar macrostructure and PLIC and genu microstructure were predictive of early neurodevelopment and gait.

Gestational age, not transient hyperthyrotropinemia impacts brain white matter diffusion tensor imaging in premature infants

“…Lower FA and higher MD values in the genu of the CC have been reported to be correlated with slower gait velocity, and lesion studies have indicated that the genus WM mediates motor coordination (29,30). Our findings are partially consistent with the previous results.…”

“…Of note, relatively higher MD values were obtained at the right side of the ALIC in the patients with motor dysfunction, although the results did not reach statistical significance. In addition, Rose et al reported that near-term ALIC MD values were correlated with BSID-III fine motor scores (29). We did not observe increases in FA in the genu and splenium of the CC in the patients with motor dysfunction, which may be due to the limited number of patients.…”

Neurologic Correlates of Gait Abnormalities in Cerebral Palsy: Implications for Treatment

“…A, anterior; P, posterior; R, right; L, left. Figure reprinted with permission from Rose et al (2015) Pediatric Research. http://www.nature.com/pr/journal/v78/n6/fig_tab/pr2015157f2.html…”

Preterm neuroimaging and neurodevelopmental outcome: a focus on intraventricular hemorrhage, post-hemorrhagic hydrocephalus, and associated brain injury

“…ELBW neonates without hydro­cephalus with higher MD PLIC scores had lower motor scores at 18–22 months [112]. In preterm infants without hydrocephalus, there is a strong negative correlation between PLIC FA and Gross Motor Function Classification System score at 4 years of age [100].…”

“…Alternatively, Arzoumanian et al showed a reduction in the FA of the posterior limb of the internal capsule (PLIC) in neurologically abnormal preterm infants compared with controls [110]. ELBWs with higher MD PLIC scores had lower cognitive scores [112]. …”