Center for Prevention of Neurodevelopmental Disorders, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
Center for Prevention of Neurodevelopmental Disorders, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Rehabilitation, Exercise, and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States.
Neuroimage Clin. 2022;34:102987. doi: 10.1016/j.nicl.2022.102987. Epub 2022 Mar 9.
Infants born very preterm (VPT) are at risk of later visual problems. Although neonatal screening can identify ophthalmologic abnormalities, subtle perinatal brain injury and/or delayed brain maturation may be significant contributors to complex visual-behavioral problems. Our aim was to assess the micro and macrostructural antecedents of early visual-behavioral difficulties in VPT infants by using diffusion MRI (dMRI) at term-equivalent age. We prospectively recruited a cohort of 262 VPT infants (≤32 weeks gestational age [GA]) from five neonatal intensive care units. We obtained structural and diffusion MRI at term-equivalent age and administered the Preverbal Visual Assessment (PreViAs) questionnaire to parents at 3-4 months corrected age. We used constrained spherical deconvolution to reconstruct nine white matter tracts of the visual pathways with high reliability and performed fixel-based analysis to derive fiber density (FD), fiber-bundle cross-section (FC), and combined fiber density and cross-section (FDC). In multiple logistic regression analyses, we related these tract metrics to visual-behavioral function. Of 262 infants, 191 had both high-quality dMRI and completed PreViAs, constituting the final cohort: mean (SD) GA was 29.3 (2.4) weeks, 90 (47.1%) were males, and postmenstrual age (PMA) at MRI was 42.8 (1.3) weeks. FD and FC of several tracts were altered in infants with (N = 59) versus those without retinopathy of prematurity (N = 132). FDC of the left posterior thalamic radiations (PTR), left inferior longitudinal fasciculus (ILF), right superior longitudinal fasciculus (SLF), and left inferior fronto-occipital fasciculus (IFOF) were significantly associated with visual attention scores, prior to adjusting for confounders. After adjustment for PMA at MRI, GA, severe retinopathy of prematurity, and total brain volume, FDC of the left PTR, left ILF, and left IFOF remained significantly associated with visual attention. Early visual-behavioral difficulties in VPT infants are preceded by micro and macrostructural abnormalities in several major visual pathways at term-equivalent age.
极早早产儿（VPT）存在后期视觉问题的风险。虽然新生儿筛查可以识别眼科异常，但围产期脑损伤和/或脑成熟延迟可能是导致复杂视觉行为问题的重要因素。我们的目的是通过在足月等效年龄时使用弥散磁共振成像（dMRI）来评估 VPT 婴儿早期视觉行为困难的微观和宏观结构前体。我们前瞻性地招募了来自五个新生儿重症监护病房的 262 名 VPT 婴儿（≤32 周胎龄[GA]）。我们在足月等效年龄时获得了结构和弥散磁共振成像，并在 3-4 个月校正年龄时向父母提供了前语言视觉评估（PreViAs）问卷。我们使用约束球解卷积以高可靠性重建九种视觉通路的白质束，并进行固定基元分析以得出纤维密度（FD）、纤维束横截面积（FC）和组合纤维密度和横截面积（FDC）。在多元逻辑回归分析中，我们将这些束度量与视觉行为功能相关联。在 262 名婴儿中，有 191 名婴儿同时具有高质量的 dMRI 和完成的 PreViAs，构成了最终队列：平均（SD）GA 为 29.3（2.4）周，90 名（47.1％）为男性，MRI 时的校正胎龄（PMA）为 42.8（1.3）周。与未患有早产儿视网膜病变（ROP）的婴儿（N=132）相比，患有ROP 的婴儿（N=59）的几个束的 FD 和 FC 发生改变。左侧后丘脑辐射（PTR）、左侧下纵束（ILF）、右侧上纵束（SLF）和左侧下额枕束（IFOF）的 FDC 与视觉注意力评分显著相关，在调整混杂因素之前。在调整 MRI 时的 PMA、GA、严重 ROP 和总脑体积后，左侧 PTR、左侧 ILF 和左侧 IFOF 的 FDC 与视觉注意力仍然显著相关。VPT 婴儿的早期视觉行为困难在前足月等效年龄时几个主要视觉通路的微观和宏观结构异常之前就已经存在。
