Department of Neonatology and Pediatric Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland.
Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
Pediatr Res. 2020 Nov;88(5):739-748. doi: 10.1038/s41390-020-1024-1. Epub 2020 Jun 26.
Executive function deficits in children born very preterm (VPT) have been linked to anatomical abnormalities in white matter and subcortical brain structures. This study aimed to investigate how altered brain metabolism contributes to these deficits in VPT children at school-age.
Fifty-four VPT participants aged 8-13 years and 62 term-born peers were assessed with an executive function test battery. Brain metabolites were obtained in the frontal white matter and the basal ganglia/thalami, using proton magnetic resonance spectroscopy (MRS). N-acetylaspartate (NAA)/creatine (Cr), choline (Cho)/Cr, glutamate + glutamine (Glx)/Cr, and myo-Inositol (mI)/Cr were compared between groups and associations with executive functions were explored using linear regression.
In the frontal white matter, VPT showed lower Glx/Cr (mean difference: -5.91%, 95% CI [-10.50, -1.32]), higher Cho/Cr (7.39%, 95%-CI [2.68, 12.10]), and higher mI/Cr (5.41%, 95%-CI [0.18, 10.64]) while there were no differences in the basal ganglia/thalami. Lower executive functions were associated with lower frontal Glx/Cr ratios in both groups (β = 0.16, p = 0.05) and higher mI/Cr ratios in the VPT group only (interaction: β = -0.17, p = 0.02).
Long-term brain metabolite alterations in the frontal white matter may be related to executive function deficits in VPT children at school-age.
Very preterm birth is associated with long-term brain metabolite alterations in the frontal white matter. Such alterations may contribute to deficits in executive function abilities. Injury processes in the brain can persist for years after the initial insult. Our findings provide new insights beyond structural and functional imaging, which help to elucidate the processes involved in abnormal brain development following preterm birth. Ultimately, this may lead to earlier identification of children at risk for developing deficits and more effective interventions.
早产儿（VPT）的执行功能缺陷与白质和皮质下脑结构的解剖异常有关。本研究旨在探讨在校龄 VPT 儿童中，改变的脑代谢如何导致这些缺陷。
评估了 54 名年龄在 8-13 岁的 VPT 参与者和 62 名足月出生的同龄人，使用执行功能测试组合。使用质子磁共振波谱（MRS）在额白质和基底节/丘脑获得脑代谢物。比较组间 N-乙酰天冬氨酸（NAA）/肌酸（Cr）、胆碱（Cho）/Cr、谷氨酸+谷氨酰胺（Glx）/Cr 和肌醇（mI）/Cr，并使用线性回归探讨与执行功能的关联。
在额白质中，VPT 显示出较低的 Glx/Cr（平均差异：-5.91%，95%CI[-10.50，-1.32]）、较高的 Cho/Cr（7.39%，95%-CI[2.68，12.10]）和较高的 mI/Cr（5.41%，95%-CI[0.18，10.64]），而基底节/丘脑则没有差异。两组的额叶 Glx/Cr 比值较低与较低的执行功能相关（β=0.16，p=0.05），而仅在 VPT 组中，mI/Cr 比值较高与较低的执行功能相关（交互作用：β=-0.17，p=0.02）。
在校龄 VPT 儿童中，额叶白质的长期脑代谢物改变可能与执行功能缺陷有关。
极早产儿出生与额叶白质的长期脑代谢物改变有关。这种改变可能导致执行功能能力的缺陷。脑损伤过程在初始损伤后可能会持续多年。我们的研究结果提供了超越结构和功能成像的新见解，有助于阐明早产儿出生后异常脑发育涉及的过程。最终，这可能导致更早地识别出有发展缺陷风险的儿童，并采取更有效的干预措施。
