Extremely preterm children and relationships of minor neurodevelopmental impairments at 6 years

Lastenneurologia, toimintaterapia, psykologiaExtremely preterm children and relationships of minor neurodevelopmental impairments at 6 years Ulla Niutanen 1 *, Piia Lönnberg 1, Elina Wolford 2 , Marjo Metsäranta 3† and Aulikki Lano 1† 1 Department of Child Neurology, New Children’s Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland, 2 Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland, 3 Department of Pediatrics, New Children’s Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland Aim: This study investigated minor impairments in neurological, sensorimotor, and neuropsychological functioning in extremely preterm-born (EPT) children compared to term-born children. The aim was to explore the most affected domains and to visualize their co-occurrences in relationship maps. Methods: A prospective cohort of 56 EPT children (35 boys) and 37 term- born controls (19 boys) were assessed at a median age of 6 years 7 months with Touwen Neurological Examination, Movement Assessment Battery for Children, 2nd edition (MABC-2), Sensory Integration and Praxis Test (SIPT), and a Developmental Neuropsychological Assessment, 2nd edition (NEPSY-II). Altogether 20 test domains were used to illustrate the frequency of impaired test performances with a bar chart profile and to construct relationship maps of co-occurring impairments. Results: The EPT children were more likely to perform inferiorly compared to the term-born controls across all assessments, with a wider variance and more co-occurring impairments. When aggregating all impaired test domains, 45% of the EPT children had more impaired domains than any term-born child (more than five domains, p < 0.001). Relationship maps showed that minor neurological dysfunction (MND), NEPSY-II design copying, and SIPT finger identification constituted the most prominent relationship of co-occurring impairments in both groups. However, it was ten times more likely in the EPT group. Another relationship of co-occurring MND, impairment in NEPSY-II design copying, and NEPSY-II imitation of hand positions was present in the EPT group only. Interpretation: Multiple minor impairments accumulate among EPT children at six years, suggesting that EPT children and their families may need support and timely multi-professional interventions throughout infancy and childhood. FrontiersPeer reviewe

A protocol for the analysis of DTI data collected from young children

Analysis of scalar maps obtained by diffusion tensor imaging (DTI) produce valuable information about the microstructure of the brain white matter. The DTI scanning of child populations, compared with adult groups, requires specifically designed data acquisition protocols that take into consideration the trade-off between the scanning time, diffusion strength, number of diffusion directions, and the applied analysis techniques. Furthermore, inadequate normalization of DTI images and non-robust tensor reconstruction have profound effects on data analyses and may produce biased statistical results. Here, we present an acquisition sequence that was specifically designed for pediatric populations, and describe the analysis steps of the DTI data collected from extremely preterm-born young school-aged children and their age- and gender-matched controls. The protocol utilizes multiple software packages to address the effects of artifacts and to produce robust tensor estimation. The computation of a population-specific template and the nonlinear registration of tensorial images with this template were implemented to improve alignment of brain images from the children.Peer reviewe

Sensory-motor performance in seven-year-old children born extremely preterm

Background: Children born preterm are prone to motor problems. Research on their motor performance has, however, rarely been integrated with sensory processing. Aim: To examine sensory-motor performance in children born extremely preterm (EPT). Method: In a longitudinal prospective cohort study, 49 EPT (born <28 gestational weeks; 32 boys and 17 girls) and 33 term-born (16 boys and 17 girls) children were assessed with six individual subtests from the Sensory Integration and Praxis Tests at the age of 7.0 to 7.3 years. Results: The rate of test z-scores indicating dysfunction [from - 2 standard deviations (SD) to <-1 SD for mild and <- 2 SD for moderate-to-severe] was significantly higher in EPT children than in term-born children in all the subtests. When comparing mean performance adjusted for gender and mother's education, EPT children performed worse than term-born children in Design Copying (z-score difference - 0.83; 95% confidence interval -1.32 to - 0.34), Motor Accuracy (- 0.82; -1.26 to - 0.38), Postural Praxis (- 0.95; -1.45 to - 0.45), Manual Form Perception (- 0.59; -1.12 to - 0.06), and Finger Identification (- 0.88; -1.45 to - 0.31). Additional adjustment for Full-Scale Intelligence Quotient rendered difference in Manual Form Perception non-significant. Conclusion: Seven-year-old EPT children perform worse than their term-born peers in tests for visual-motor, somatosensory, and motor planning performance.Peer reviewe

Postnatal N‑acetylcysteine does not provide neuroprotection in extremely low birth weight infants : A follow-up of a randomized controlled trial

Corrigendum, DOI: 10.1016/j.earlhumdev.2019.05.004.Peer reviewe

Secondary somatosensory cortex evoked responses and 6-year neurodevelopmental outcome in extremely preterm children

Objective: We assessed in extremely preterm born (EPB) children whether secondary somatosensory cor-tex (SII) responses recorded with magnetoencephalography (MEG) at term-equivalent age (TEA) correlate with neurodevelopmental outcome at age 6 years. Secondly, we assessed whether SII responses differ between 6-year-old EPB and term-born (TB) children. Methods: 39 EPB children underwent MEG with tactile stimulation at TEA. At age 6 years, 32 EPB and 26 TB children underwent MEG including a sensorimotor task requiring attention and motor inhibition. SII responses to tactile stimulation were modeled with equivalent current dipoles. Neurological outcome, motor competence, and general cognitive ability were prospectively evaluated at age 6 years. Results: Unilaterally absent SII response at TEA was associated with abnormal motor competence in 6-year-old EPB children (p = 0.03). At age 6 years, SII responses were bilaterally detectable in most EPB (88%) and TB (92%) children (group comparison, p = 0.69). Motor inhibition was associated with decreased SII peak latencies in TB children, but EPB children lacked this effect (p = 0.02). Conclusions: Unilateral absence of an SII response at TEA predicted poorer motor outcome in EPB children. Significance: Neurophysiological methods may provide new means for outcome prognostication in EPB children. (c) 2021 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).Peer reviewe

Latent class growth analysis identified different trajectories in cognitive development of extremely low birthweight children

Background Recent longitudinal studies suggest stable cognitive development in preterm children, although with great individual variation. This prospective neurocognitive follow-up study of extremely low birthweight (ELBW, 115) showed stable development (-3.2 points, p=0.250). Multiple linear regression showed that neonatal complications (intraventricular haemorrhage grade 3-4 and blood culture positive sepsis) and maternal education significantly predicted lower intelligence at the second assessment (F(3,106)=7.27, pPeer reviewe

Preterm Birth Changes Networks of Newborn Cortical Activity

CORRIGENDUM: DOI: 10.1093/cercor/bhy100 Published: APR 2019Preterm birth is the greatest risk factor for lifelong neurocognitive deficits, globally. The effect of prematurity on early cortical network function has, however, remained poorly understood. Here, we developed a novel methodology that allows reliable assessment of functional connectivity in neonatal brain activity at millisecond and multisecond scales in terms of cortical phase and amplitude correlations, respectively. We measured scalp electroencephalography at term-equivalent age in infants exposed to very early prematurity as well as in healthy controls. We found that newborn cortical activity organizes into multiplex networks that differ significantly between vigilance states. As compared with healthy control infants, prematurity was found to cause frequency-specific patterns of dysconnectivity in cortical network, changes that were distinct for networks of phase and amplitude correlations. Neuroanatomically, the most prominent markers of prematurity were found in connections involving the frontal regions. Phase synchrony in frontally connected networks was correlated with newborn neurological performance, suggesting the first measure of cortical functional coupling that correlates with neurological performance in human infant.Peer reviewe

Neurocognitive outcome in young adults born late-preterm

Aim This study examined whether late-preterm birth (34+0 to 36+6wks+d gestational age) was associated with neurocognitive deficit in young adulthood, and whether small for gestational age (SGA) birth amplified any adversity. Method Participants derived from the prospective regional cohort study, the Arvo Ylppö Longitudinal Study (n=786; 398 females, 388 males) (mean age 25y 4mo, SD 8mo), born 1985 to 1986 late-preterm (n=119; 21 SGA, <−2 SD) and at term (37+0 to 41+6wks+d; n=667; 28 SGA) underwent tests of intelligence, executive functioning, attention, and memory, and reported their education. Results Those born late-preterm scored −3.71 (95% confidence interval [CI] −6.71 to −0.72) and −3.11 (95% CI −6.01 to −0.22) points lower on Full-scale and Verbal IQ than peers born at term. Compared with those born at term and appropriate for gestational age (≥−2 to <2 SD) Full-scale, Verbal, and Performance IQ scores of those born late-preterm and SGA were −9.45 to −11.84 points lower. After adjustments, differences were rendered non-significant, except that scores in Full-scale and Performance IQ remained lower among those born late-preterm and SGA. Interpretation Late-preterm birth, per se, may not increase the risk of poorer neurocognitive functioning in adulthood. But the double burden of being born late-preterm and SGA seems to increase this risk

Maternal early pregnancy body mass index and diurnal salivary cortisol in young adult offspring

Background Maternal early pregnancy overweight (body mass index [BMI] 25.0-29.9 kg/m(2)) and obesity (BMI >= 30 kg/m(2)) are associated with mental and physical health adversities in the offspring. Prenatal programming of the hypothalamic-pituitary-adrenal (HPA) axis has been put forward as one of the mechanisms that may play pathophysiological role. However, evidence linking maternal overweight and obesity with offspring HPA-axis activity is scarce. We studied if maternal early pregnancy BMI is associated with diurnal salivary cortisol, a marker of HPA-axis activity, in young adult offspring. Methods At a mean age of 25.3 (standard deviation [SD) = 0.6) years, 653 Arvo Ylppo Longitudinal Study participants collected saliva samples for cortisol analyses, at awakening, 15 and 30 min thereafter, 10:30AM, 12:00PM, 5:30PM and at bedtime. Maternal BMI was calculated from weight and height verified by a measurement in the first antenatal clinic visit before 12 weeks of gestation derived from healthcare records. Results Per each one kg/m(2) higher maternal early pregnancy BMI offspring diurnal average salivary cortisol was -1.4% (95% CI:-2.6, -0.2, p(FDR) = 0.033) lower, at awakening it was -2.4% (95% CI:-4.0, -0.7, p(FDR) = 0.025) lower and the morning average salivary cortisol was -2.0% (95% CI:-3.4,-0.5, p(FDR) = 0.017) lower. These associations were independent of the offspring's own young adulthood BMI, and other important covariates. Conclusion Our findings show that young adult offspring born to mothers with higher early pregnancy BMI show lower average levels of diurnal cortisol, especially in the morning. Whether these findings reflect prenatal programming of the offspring HPA-axis activity warrants further investigation.Peer reviewe