Anderson Kathryn G, Lazarus Molly F, Bruckert Lisa, Poblaciones Rocio V, Scala Melissa, Marchman Virginia A, Feldman Heidi M, Travis Katherine E
Stanford University School of Medicine, Stanford, CA, USA.
Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, Stanford University, Stanford, CA, USA.
Neuroimage Rep. 2024 Dec;4(4). doi: 10.1016/j.ynirp.2024.100226. Epub 2024 Nov 26.
Severe neonatal inflammatory conditions in very preterm infants (VPT: <32 weeks gestational age, GA) are linked to adverse neurodevelopmental outcomes. Differences in white matter (WM) microstructure of the corpus callosum (CC) have been observed at age 6 in VPT children with a history of severe neonatal inflammation. The goal of this study was to determine whether these CC differences can be detected at term-equivalent age using diffusion MRI (dMRI), and whether neonatal inflammation is associated with altered WM in additional tracts implicated in the encephalopathy of prematurity.
We conducted a retrospective study of VPT infants ( = 152) born at 22-32 weeks GA, classified based on the presence (I+, = 80) or absence (I-, = 72) of severe neonatal inflammatory conditions (bronchopulmonary dysplasia, necrotizing enterocolitis, or culture-positive sepsis). Analysis of covariance (ANCOVA) assessed group differences in near-term dMRI mean fractional anisotropy (FA) and mean diffusivity (MD) across seven segments of the CC and the anterior thalamic radiation, arcuate fasciculus, cingulum, corticospinal tract, inferior longitudinal fasciculus, superior cerebellar peduncle, and uncinate fasciculus. Due to imbalance of GA in the full sample, secondary ANCOVA analyses were performed in a GA-matched subset ( = 42) to further isolate the effect of inflammation.
FA was significantly lower in the I+ group compared to the I- group in the anterior frontal, posterior parietal, temporal, and occipital segments of the CC, and in the cingulum, inferior longitudinal fasciculus, and superior cerebellar peduncle. This general pattern persisted in the GA-matched subset, with significant differences in the anterior frontal and temporal CC segments.
VPT infants with severe neonatal inflammation had lower FA in multiple white matter tracts, suggesting that inflammation-related alterations in WM development begin in the neonatal period. The observed differences detected using dMRI at term-equivalent age corroborate prior findings and may provide a window of opportunity for early identification of VPT infants at increased risk of poor neurodevelopmental outcomes.
极早产儿（VPT：胎龄<32周）的严重新生儿炎症性疾病与不良神经发育结局相关。有严重新生儿炎症病史的VPT儿童在6岁时，胼胝体（CC）的白质（WM）微观结构存在差异。本研究的目的是确定使用扩散磁共振成像（dMRI）在足月等效年龄时是否能检测到这些CC差异，以及新生儿炎症是否与早产儿脑病相关的其他神经束中WM的改变有关。
我们对22 - 32周胎龄出生的VPT婴儿（n = 152）进行了一项回顾性研究，根据是否存在严重新生儿炎症性疾病（支气管肺发育不良、坏死性小肠结肠炎或血培养阳性败血症）分为两组（I +组，n = 80；I -组，n = 72）。协方差分析（ANCOVA）评估了CC的七个节段以及丘脑前辐射、弓状束、扣带束、皮质脊髓束、下纵束、上小脑脚和钩束在近足月dMRI平均分数各向异性（FA）和平均扩散率（MD）方面的组间差异。由于全样本中胎龄不均衡，在一个胎龄匹配的亚组（n = 42）中进行了二次ANCOVA分析，以进一步分离炎症的影响。
与I -组相比，I +组在CC的额前、顶后、颞和枕节段以及扣带束、下纵束和上小脑脚的FA显著降低。这种总体模式在胎龄匹配的亚组中持续存在，在额前和颞CC节段存在显著差异。
患有严重新生儿炎症的VPT婴儿在多个白质束中的FA较低，这表明WM发育中与炎症相关的改变始于新生儿期。在足月等效年龄使用dMRI观察到的差异证实了先前的研究结果，并可能为早期识别神经发育结局不良风险增加的VPT婴儿提供一个机会窗口。
