Peterson Bradley S, Delavari Sahar, Sadik Jonathan, Ersland Lars, Elgen Irene B, Sawardekar Siddhant, Bansal Ravi, Aukland Stein Magnus
Institute for the Developing Mind, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Department of Psychiatry, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA.
J Child Psychol Psychiatry. 2025 May;66(5):635-649. doi: 10.1111/jcpp.14069. Epub 2024 Nov 19.
Fifteen million infants annually are born prematurely, placing them at high risk for life-long adverse neurodevelopmental outcomes. Whether brain tissue abnormalities that accompany preterm birth persist into young adulthood and are associated with long-term cognitive or psychiatric outcomes is not known.
From infancy into young adulthood, we followed a population-based sample of consecutively identified preterm infants and their matched term controls. The preterm group was born at an average gestational age of 31.5 ± 2.6 weeks. We obtained Diffusion Tensor Imaging scans and assessed cognitive and psychiatric outcomes in young adulthood, at a mean age of 19 (range 17.6-20.8) years. Usable data were acquired from 180 participants (89 preterm, 91 term).
Preterm birth was associated with lower fractional anisotropy (FA) and higher average diffusion coefficient (ADC) values in deep white matter tracts of the internal capsule, cerebral peduncles, inferior frontal-occipital fasciculus, sagittal stratum and splenium of the corpus callosum, as well as in grey matter of the caudate, putamen and thalamus. A younger gestational age at birth accentuated these tissue abnormalities. Perinatal characteristics, including lower 5-min APGAR score, history of bronchopulmonary dysplasia, more days of oxygen supplementation and multiple births all increased ADC values in deep white matter tracts and grey matter throughout the brain. Preterm individuals had significantly lower full-scale IQ and more frequent lifetime psychiatric disorders. Those with psychiatric illnesses had significantly higher ADC and lower FA values throughout the deep posterior white matter.
Abnormalities in brain tissue microstructure associated with preterm birth persist into young adulthood and likely represent disordered myelination and accompanying axonal pathology. These disturbances are associated with a higher likelihood of developing a psychiatric disorder by young adulthood. Brain tissue disturbances were accentuated in those born at younger gestational ages and in those with a history of perinatal complications associated with infection and inflammation.
每年有1500万婴儿早产，这使他们面临终身不良神经发育结局的高风险。尚不清楚早产伴随的脑组织异常是否会持续到青年期，并与长期认知或精神结局相关。
从婴儿期到青年期，我们对一组基于人群的连续识别的早产婴儿及其匹配的足月儿对照进行了随访。早产组的平均胎龄为31.5±2.6周。我们获得了扩散张量成像扫描，并在青年期（平均年龄19岁，范围17.6 - 20.8岁）评估了认知和精神结局。从180名参与者（89名早产，91名足月）获得了可用数据。
早产与内囊、大脑脚、额枕下束、矢状层和胼胝体压部的深部白质束以及尾状核、壳核和丘脑的灰质中较低的各向异性分数（FA）和较高的平均扩散系数（ADC）值相关。出生时胎龄越小，这些组织异常越明显。围产期特征，包括较低的5分钟阿氏评分、支气管肺发育不良病史、更多的吸氧天数和多胎妊娠，均增加了全脑深部白质束和灰质中的ADC值。早产个体的全量表智商显著较低，终身精神疾病的发生率更高。患有精神疾病的个体在整个深部后白质中的ADC值显著更高，FA值更低。
与早产相关的脑组织微观结构异常持续到青年期，可能代表髓鞘形成紊乱及伴随的轴突病变。这些紊乱与青年期患精神疾病的可能性增加有关。在胎龄较小以及有与感染和炎症相关的围产期并发症病史的个体中，脑组织紊乱更为明显。
