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The role of intrinsic activity in cortical development
PROFILES OF MOTOR, COGNITIVE, AND BEHAVIORAL OUTCOMES OF VERY PRETERM BORN CHILDREN IN FRANCE AT 5.5 YEARS OF AGE: RESULTS FROM THE EPIPAGE-2 STUDY
Very preterm born children are at risk for impairments in multiple developmental domains, but outcomes are heterogeneous. Our study aimed to distinguish subgroups with distinct profiles of functioning across cognitive, motor, behavioral, and psychosocial domains. These profiles were related to neonatal and social/environmental factors.
The sample included 1,977 children born very preterm (<32 weeks’ gestation) in 2011 from the French population-based EPIPAGE-2 cohort. Using latent profile analysis, subgroups of children were distinguished based on motor, cognitive, behavioral, and psychosocial functioning at 5.5 years. The relation between outcome profiles and 11 neonatal and social/environmental factors was tested using multivariable multinomial logistic regression analysis.
Four subgroups with distinct outcome profiles were distinguished: no deficits in any domain (45%), motor and cognitive deficits without behavioral/psychosocial deficits (31%), primarily behavioral and psychosocial deficits (16%), and moderate/severe deficits in multiple domains (8%). Male sex (OR=2.1-2.7), bronchopulmonary dysplasia (OR=2.1-2.8), low parental education level (OR=1.8-2.2), and parental non-European migrant status (OR=2.3-2.9) were independently associated with higher odds for all suboptimal outcome profiles compared to the favorable outcome profile.
Among 5.5-year-old very preterm born children, subgroups can be distinguished with distinct outcome profiles that vary in severity, type, and combinations of deficits. This information is important for the development of interventions that are tailored to the needs of large subgroups of children across multiple domains of functioning. General neonatal and social/environmental factors available at discharge may be useful for early identification of very preterm born children at risk for domain-general rather than domain-specific impairments.
BRAIN DEVELOPMENT IS IMPAIRED IN FETUSES AND NEONATES WITH CRITICAL CONGENITAL HEART DISEASE
Background and aims
Despite growing evidence for impaired prenatal brain development in the critical congenital heart disease (CCHD) population, the degree and regional distribution of volumetric deficits remain unclear. Our aim was to compare global and regional brain volumes and longitudinal brain growth in fetuses and neonates with CCHD to healthy controls.
A prospective cohort study was performed in fetuses and neonates with CCHD undergoing cardiac surgery with cardiopulmonary bypass and healthy controls. Subjects with fetal and/or neonatal preoperative 3-Tesla MRI-scans were included. T2-weighted images were segmented. Volumes of total brain (TB), cortical grey matter (CGM), deep grey matter (DGM), unmyelinated white matter (UWM), brainstem (BS), and cerebellum (CB) were calculated. Volumes were compared by linear regression analysis with correction for postmenstrual age (PMA) at scan, gender and birth weight. Linear mixed model analysis was used to assess longitudinal brain growth.
Eighty-four subjects (58 CCHD, 26 controls) were included. At fetal MRI (mean PMA 33.0 weeks; SD 1.2) only BS volume differed between CCHD and controls (-15% in CCHD; p<0.03). At preoperative MRI (PMA 40.6 weeks; SD 1.8), TB (-11%), CGM (-14%), UWM (-10%) and CB (-11%) volumes were lower in CCHD, compared to controls (all p<0.03). Longitudinal growth of TB (-10.8%; p<0.05) and CGM (-24.4%; p<0.01) was decreased in CCHD.
Global and regional brain development is impaired in fetuses and neonates with CCHD compared to healthy controls. The extent of volumetric delay increases over the third trimester and is most evident in the cortical grey matter.