Regional Cerebral Development at Term Relates to School-Age Social–Emotional Development in Very Preterm Children

Abstract

Objective Preterm children are at risk for social-emotional difficulties, including autism and attention deficit hyperactivity disorder. We assessed the relationship of regional brain development in preterm children, evaluated via MRI at term-equivalent postmenstrual age (TEA), to later social-emotional difficulties. Method MR images obtained at TEA from 184 very preterm infants (gestation <30 weeks or birthweight <1250 g) were analyzed for white matter abnormalities, hippocampal volume, and brain metrics. 111 infants underwent diffusion tensor imaging, which provided values for fractional anisotropy (FA) and apparent diffusion coefficient (ADC). Social-emotional development was assessed with the Infant Toddler Social and Emotional Assessment (ITSEA) at age 2 and the Strengths and Difficulties Questionnaire (SDQ) at age 5. Results Higher ADC in the right orbitofrontal cortex was associated with social-emotional problems at age 5 (peer problems, p<0.01). In females, smaller hippocampal volume was associated with increased hyperactivity (p<0.01), peer problems (p<0.05) and SDQ total score (p<0.01). In males, a smaller frontal region was associated with poorer prosocial (p<0.05) scores. Many of the hippocampal findings remained significant after adjusting for birthweight z score, intelligence, social risk, immaturity at birth, and parental mental health. These associations were present in children who had social-emotional problems in similar domains at age 2 and those who did not. Conclusions Early alterations in regional cerebral development in very preterm infants relate to specific deficits in social-emotional performance by school-age. These results vary by gender. Our results provide further evidence for a neuroanatomical basis for behavioral challenges found in very preterm children.

Personality of adults who were born very preterm

“…The higher scores of VP/VLBW adults on the socially withdrawn personality factor are most likely to be a result of alterations in their brain structure and functioning due to the amalgam of changes in brain development related to premature birth and prenatal and neonatal insult26 Moreover, poor peer relations and social–emotional problems in childhood are associated with regional disruptions in the white matter, in the right orbital frontal cortex which is a region involved in social regulations, social cognition and theory of mind 27…”

Prenatal cocaine effects on brain structure in early infancy

“…It remains to be determined whether this pattern holds true for brain development. Imaging data from non-exposed children born prematurely suggest that prematurity-related deficits in brain structure persist and underlie developmental impairments at school age (Lowe et al 2012; Rogers et al 2012), with delay in some, but not all, processes of cortical maturation (Phillips et al 2011). Adolescents with PCE show reductions in frontal cortical volumes, however this finding is not consistent across all imaging studies of exposed children and adolescents (Smith et al 2001; Dow-Edwards et al 2006; Avants et al 2007; Rao et al 2007; Rivkin et al 2008; Roussotte et al 2010).…”

The paradox of prematurity: The behavioral vulnerability of late preterm infants and the cognitive susceptibility of very preterm infants at 36 months post-term

“…Preterm categories were created based on gestational age cut-points that have been previously used to compare preterm groups (Davidoff, et al, 2006; Raju, et al, 2006; Rogers et al, 2012; Spittle et al, 2009): very preterm infants (VPI) born <30 weeks of gestation, moderate preterm infants (MPI) born 30–33 6/7 weeks of gestation, and late preterm infants (LPI) born 34–36 6/7 weeks of gestation.…”