Tract-Based Spatial Statistics in Preterm-Born Neonates Predicts Cognitive and Motor Outcomes at 18 Months

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Fig 1.
Participant flow chart. Neonate data (180 very preterm-born infants of <32 weeks' gestation, with 1 or 2 MR imaging scanning sessions including DTI) are separated into 3 groups: group 1, 75 neonates with only 1 early scan near the time of birth (median postmenstrual age at scanning, 32 weeks) (all 75 neonates have neurodevelopmental follow-up data at 18-month corrected age); group 2, 78 neonates with 2 scans, both early (PMA, 32 weeks) and at term-equivalent age (PMA, 39.7 weeks) (75 neonates have follow-up data); group 3, 27 neonates with a late scan (PMA, 39 weeks) (16 neonates have follow-up data).
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Fig 2.
TBSS analysis of term scans (PMA of 37–41-weeks). Top: Mean FA map (red-yellow) demonstrating the significant positive linear association between cognitive scores on the Bayley-III and FA in the territory of the medial prefrontal cortex (left), the genu of the corpus callosum (middle), and portions of the inferior fronto-occipital fasciculus (right, P < .05, corrected for multiple comparisons). The mean FA skeleton is shown in green. Bottom: FA (R = 0.3, P = .03), AD (R = −0.1, P = .2), and RD (R = −0.2, P = .03) values from the significant clusters in the FA map. Spearman ρ correlation and an α level are set at .05.

Table 1:

Clinical characteristics: separated into groups based on the postmenstrual age at scanning^{^a}

	27–29 Weeks (n = 24) (Median) (IQR) or (No.) (%)	30–33 Weeks (n = 99) (Median) (IQR) or (No.) (%)	34–36 Weeks (n = 34) (Median) (IQR) or (No.) (%)	37–41 Weeks (n = 101) (Median) (IQR) or (No.) (%)
Birth GA (wks)	27.3 (26.1–27.8)	29.3 (27.5–30.6)	26.1 (25–27.7)	26.9 (25.9–29.7)
Age at MRI (wks)	29 (28.5–29.4)	32 (30.9–32.9)	35.1 (34.5–36.3)	39.7 (38.6–40.6)
Sex (male)	12 (50%)	57 (57%)	16 (47%)	54 (53%)
Birth weight (g)	1022.5 (911.5–1171.3)	1140 (957.5–1377.5)	749 (607.5–1002.5)	970 (805–1270)
Days of mechanical ventilation	2 (1–5.8)	3 (1–10.5)	37.5 (20.5–51.3)	11.5 (2–51)
Infection^{^b}	11 (46%)	31 (31%)	19 (56%)	49 (49%)
Patent ductus arteriosus	9 (38%)	38 (38%)	27 (79%)	47 (47%)
Chronic lung disease	5 (21%)	10 (10%)	17 (50%)	27 (27%)

Note:—GA indicates gestational age.
↵a One hundred eighty neonates participated. Seventy-five neonates had early scans (near birth), 78 neonates were scanned early and late (birth, term-equivalent age), and 27 neonates were scanned late (term-equivalent age), for a total of 258 scans.
↵b Infection, culture-positive infection, confirmed necrotizing enterocolitis.

Table 2:

Radiologic findings: separated into groups based on the postmenstrual age at scanning^{^a}

	27–29 Weeks (n = 24) (No.) (%)	30–33 Weeks (n = 99) (No.) (%)	34–36 Weeks (n = 34) (No.) (%)	37–41 Weeks (n = 101) (No.) (%)
WMI (moderate/severe)^{^b}	6 (25%)	15 (15%)	4 (12%)	12 (12%)
IVH (grade 1/2)^{^c}	10 (42%)	40 (40%)	18 (53%)	33 (33%)
IVH (grade 3/4)^{^c}	1 (4%)	2 (2%)	1 (3%)	2 (2%)
Cerebellar hemorrhage	2 (8%)	11 (11%)	5 (15%)	12 (12%)

Note:—WMI indicates white matter injury.
↵a One hundred eighty neonates participated. Seventy-five neonates had early scans (near birth), 78 neonates were scanned early and late (birth, term-equivalent age), and 27 neonates were scanned late, for a total of 258 scans.
↵b WMI defined as foci exhibiting T1 hyperintensity without T2 hypointensity or by low-intensity T1 foci.
↵c IVH was graded (none = 0, mild = 1–2, and moderate-severe = 3–4) using the Papile system.

Table 3:

Neurodevelopmental outcome: separated into groups by postmenstrual age at scanning^{^a}

	27–29 Weeks (n = 22) (Median) (IQR)	30–33 Weeks (n = 93) (Median) (IQR)	34–36 Weeks (n = 32) (Median) (IQR)	37–41 Weeks (n = 94) (Median) (IQR)
Age at follow-up (mo)^{^b}	18.7 (18.4–19.2)	18.7 (18.3–19.7)	18.6 (18.3–19.1)	18.8 (18.4–19.4)
Bayley-III cognitive^{^c}	105 (100–110)	110 (100–115)	102.5 (92.5–110)	105 (95–110)
Bayley-III language^{^c}	101.5 (83.5–111.3)	100 (91–109)	95.5 (83–109)	100 (86.8–108.3)
Bayley-III motor^{^c}	98.5 (88.8–105.3)	100 (91.8–107)	92.5 (84.3–104)	97 (88–107)
PDMS-2 Gross Motor^{^c}	91 (87–96)	94 (87–98)	89 (79–96)	91 (87–98)
PDMS-2 Fine Motor^{^c}	100 (97–106)	100 (97–103)	97 (89.5–103)	100 (94–103)
PDMS-2 Total Motor^{^c}	96 (90–101)	96 (92–98)	92 (84–97)	94 (89–98)

↵a One hundred sixty-six neonates returned for neurodevelopmental follow-up. DTI data were acquired in 75 of the neonates early and in 75 of the neonates at early and late time points (150 scans). Sixteen neonates had late scans for a total of 241 scans.
↵b Age corrected for prematurity.
↵c The mean composite score in a normative population is 100 ± 15.