Early brain morphometrics from neonatal MRI predict motor and cognitive outcomes at 2-years corrected age in very preterm infants

Assessing neonatal brain glymphatic system development using diffusion tensor imaging along the perivascular space and choroid plexus volume

PURPOSE

Neonatal brain development constitutes a critical period of structural and functional maturation underpinning sensory, motor, and cognitive capacities. The glymphatic system-a cerebral waste clearance network-remains poorly understood in neonates. We investigated non-invasive magnetic resonance imaging (MRI) biomarkers of glymphatic system and their developmental correlates in neonates.

METHODS

In 117 neonates undergoing high-resolution T1-weighted and diffusion MRI, we quantified two glymphatic metrics: (1) diffusion tensor imaging along the perivascular space (DTI-ALPS) index, reflecting perivascular fluid dynamics; (2) choroid plexus (CP) volume, a cerebrospinal fluid (CSF) production marker. Associations with postmenstrual age (PMA) at MRI scan, gestational age (GA), birth weight (BW), and sex were analyzed using covariate-adjusted models.

RESULTS

Preterm neonates displayed significantly reduced DTI-ALPS indices versus term neonates (total index: 1.01 vs. 1.05, P = 0.002), with reductions persisting after adjustment (P < 0.05). CP volumes showed right-dominant pre-adjustment differences (preterm: 0.33 vs. term: 0.39, P = 0.039) that attenuated post-adjustment (P = 0.348). DTI-ALPS indices demonstrated transient correlations with PMA/GA/BW in unadjusted analyses (P < 0.05), whereas CP volumes maintained robust PMA associations post-adjustment in all neonates (P = 0.037) and term subgroup (P = 0.013). No significant effects of sex on both metrics were observed.

CONCLUSION

Our findings reveal prematurity-associated delays in glymphatic maturation, rather than biological sex. The persistent PMA-CP volume relationship suggests developmental regulation of CSF production, while attenuated DTI-ALPS correlations highlight covariate-mediated effects. These glymphatic metrics show potential for monitoring neurodevelopmental trajectories, though longitudinal validation is required to establish their clinical utility in neonatal care.

CLINICAL TRIAL NUMBER

Not applicable.

Cortical scaling of the neonatal brain in typical and altered development

Theoretically derived scaling laws capture the nonlinear relationships between rapidly expanding brain volume and cortical gyrification across mammalian species and in adult humans. However, the preservation of these laws has not been comprehensively assessed in typical or pathological brain development. Here, we assessed the scaling laws governing cortical thickness (CT), surface area (SA), and cortical folding in the neonatal brain. We also assessed multivariate morphological terms that capture brain size, shape, and folding processes. The sample consisted of 345 typically developing infants, 73 preterm infants, and 107 infants with congenital heart disease (CHD) who underwent brain MRI. Our results show that typically developing neonates and those with CHD follow the cortical folding scaling law obtained from mammalian brains, children, and adults which captures the relationship between exposed SA, total SA, and CT. Cortical folding scaling was not affected by gestational age at birth, postmenstrual age at scan, sex, or multiple birth in these populations. CHD was characterized by a unique reduction in the multivariate morphological term capturing size, suggesting that CHD affects cortical growth overall but not cortical folding processes. In contrast, preterm birth was characterized by altered cortical folding scaling and altered shape, suggesting that the developmentally programmed processes of cortical folding are disrupted in this population. The degree of altered shape was associated with cognitive abilities in early childhood in preterm infants.

Antenatal Opioid Exposure and Global and Regional Brain Volumes in Newborns

Importance

Although antenatal opioid exposure is associated with impaired brain growth, previous studies are limited by small sample sizes and lack of controls. As a result, the impacts of opioid exposure on the developing brain remain poorly understood.

Objective

To compare global, regional, and tissue-specific brain volumes in opioid-exposed newborns vs unexposed controls.

Design, Setting, and Participants

In the OBOE (Outcomes of Babies with Opioid Exposure) study, term newborns with antenatal opioid exposure and unexposed controls were recruited at 4 sites in the US from August 2020 to December 2023. Data analysis was performed from August 2020 to December 2024.

Main Outcomes and Measures

The primary outcome was brain volumes in both groups, assessed via unsedated 3-dimensional (3-D) volumetric magnetic resonance imaging (MRI) in opioid-exposed and unexposed newborns prior to 8 weeks of age. T2-weighted MRI data were acquired on Siemens and Philips 3T scanners and harmonized across sites. Brains were segmented using DrawEM- and 3D U-Net-based pipelines and manual corrections. Brain volumes were compared between groups using analysis of covariance, adjusting for postmenstrual age at MRI, sex, birth weight, maternal smoking, and maternal education.

Results

A total of 173 newborns with antenatal opioid exposure and 96 unexposed controls were studied. MRIs were performed at a mean (SD) age of 42.84 (2.11) postmenstrual weeks, and 117 newborns (43.5%) were female. The opioid-exposed group had significantly smaller total brain volume (387.51 vs 407.06 cm3; difference, 19.55; 95% CI, 8.75-30.35) and cortical (167.07 vs 176.35 cm3; difference, 9.28; 95% CI, 3.86-14.70), deep gray matter (27.22 vs 28.76 cm3; difference, 1.54; 95% CI, 0.66-2.43), white matter (159.90 vs 166.65 cm3; difference, 6.76; 95% CI, 1.71-11.81), cerebellar (23.47 vs 24.99 cm3; difference, 1.52; 95% CI, 0.67-2.36), brainstem (6.80 vs 7.18 cm3; difference, 0.38; 95% CI, 0.19-0.57), and amygdala volumes (left: 0.48 vs 0.51 cm3; difference, 0.03; 95% CI, 0.004-0.05; right: 0.51 vs 0.55 cm3; difference, 0.04; 95% CI, 0.08-0.07) compared to controls. Methadone-exposed newborns showed significantly smaller white matter volume compared to controls, while buprenorphine-exposed newborns showed significantly smaller right amygdala volume than controls. Compared to controls, newborns exposed to opioids only and those exposed to opioids plus other substances both showed significant reductions in volumes of cortical and deep gray matter, cerebellum, brainstem, right amygdala, and total brain. Polysubstance-exposed newborns additionally showed smaller volumes in white matter and the left amygdala compared to controls.

Conclusions and Relevance

In a large cohort of antenatally opioid-exposed newborns, there were significant reductions in global and regional brain volumes compared to unexposed controls. These data suggest vulnerability of the developing brain to antenatal opioid exposure, with varying effects depending on the type and number of substances.

Trial Registration

ClinicalTrials.gov Identifier: NCT04149509.

Machine learning techniques for predicting neurodevelopmental impairments in premature infants: a systematic review

Background and objective

Very preterm infants are highly susceptible to Neurodevelopmental Impairments (NDIs), including cognitive, motor, and language deficits. This paper presents a systematic review of the application of Machine Learning (ML) techniques to predict NDIs in premature infants.

Methods

This review presents a comparative analysis of existing studies from January 2018 to December 2023, highlighting their strengths, limitations, and future research directions.

Results

We identified 26 studies that fulfilled the inclusion criteria. In addition, we explore the potential of ML algorithms and discuss commonly used data sources, including clinical and neuroimaging data. Furthermore, the inclusion of omics data as a contemporary approach employed, in other diagnostic contexts is proposed.

Conclusions

We identified limitations and emphasized the significance of employing multimodal data models and explored various alternatives to address the limitations identified in the reviewed studies. The insights derived from this review guide researchers and clinicians toward improving early identification and intervention strategies for NDIs in this vulnerable population.

Diagnostic accuracy of neonatal structural MRI scores to predict 6-year motor outcomes of children born very preterm

AIMS

This study aimed to (1) evaluate associations between Early and Term structural MRI (sMRI) brain abnormality scores and adverse motor outcomes at 6-years corrected age (CA), (2) determine their diagnostic accuracy in predicting adverse motor outcomes and cerebral palsy (CP) at 6-years CA.

METHODS

Infants born < 31-weeks gestational age (GA) returning for 6-year follow-up were included. Early and Term sMRI were scored using a validated method, deriving white matter, cortical grey matter, deep grey matter, cerebellar and global brain abnormality scores (GBAS). At 6-years CA, Movement Assessment Battery for Children-2nd Edition (MABC-2) was administered. Linear regression assessed associations between Early and Term GBAS/subscale scores and 6-year MABC-2 total score. For diagnostic accuracy, sMRI scores were categorised as none/mild vs moderate/severe, MABC-2 cut-off ≤ 5th percentile, and CP as present/absent.

RESULTS

Infants had Early MRI (n = 123) at mean PMA 32.5-weeks (median GA 28.4-weeks; mean birthweight 1101 g) and n = 114 had Term MRI (Mean PMA 40.8-weeks). Nine had CP and n = 116 had MABC-2 scores. Early (B: -1.92; p ≤ 0.001) and Term (B: -1.67; p ≤ 0.01) GBAS were negatively associated with MABC-2 scores. Both Early and Term GBAS had high specificity (Sp) and low sensitivity (Se) in predicting MABC-2 ≤ 5th percentile (Early: Se 36 %, Sp 82 %; Term: Se 28 %, Sp 93 %) and predicted CP with high Se and Sp (Early: Se 78 %, Sp 78 %; Term: Se 75 %, Sp 89 %).

CONCLUSION

High Sp of Early and Term MRI predicting an outcome on MABC-2 may help accurately identify infants unlikely to develop motor impairments at 6-years CA.

Multilabel SegSRGAN-A framework for parcellation and morphometry of preterm brain in MRI

Magnetic resonance imaging (MRI) is a powerful tool for observing and assessing the properties of brain tissue and structures. In particular, in the context of neonatal care, MR images can be used to analyze neurodevelopmental problems that may arise in premature newborns. However, the intrinsic properties of newborn MR images, combined with the high variability of MR acquisition in a clinical setting, result in complex and heterogeneous images. Segmentation methods dedicated to the processing of clinical data are essential for obtaining relevant biomarkers. In this context, the design of quality control protocols for the associated segmentation is a cornerstone for guaranteeing the accuracy and usefulness of these inferred biomarkers. In recent work, we have proposed a new method, SegSRGAN, designed for super-resolution reconstruction and segmentation of specific brain structures. In this article, we first propose an extension of SegSRGAN from binary segmentation to multi-label segmentation, leading then to a partitioning of an MR image into several labels, each corresponding to a specific brain tissue/area. Secondly, we propose a segmentation quality control protocol designed to assess the performance of the proposed method with regard to this specific parcellation task in neonatal MR imaging. In particular, we combine scores derived from expert analysis, morphometric measurements and topological properties of the structures studied. This segmentation quality control can enable clinicians to select reliable segmentations for clinical analysis, starting with correlations between perinatal risk factors, regional volumes and specific dimensions of cognitive development. Based on this protocol, we are investigating the strengths and weaknesses of SegSRGAN and its potential suitability for clinical research in the context of morphometric analysis of brain structure in preterm infants, and to potentially design new biomarkers of neurodevelopment. The proposed study focuses on MR images from the EPIRMEX dataset, collected as part of a national cohort study. In particular, this work represents a first step towards the design of 3-dimensional neonatal brain morphometry based on segmentation. The (free and open-source) code of multilabel SegSRGAN is publicly available at the following URL: https://doi.org/10.5281/zenodo.12659424.

Thalamic volume in very preterm infants: associations with severe brain injury and neurodevelopmental outcome at two years

Introduction

Several studies demonstrate the relationship between preterm birth and a reduced thalamus volume at term-equivalent age. In contrast, this study aims to investigate the link between the thalamic growth trajectory during the early postnatal period and neurodevelopment at two years of age.

Methods

Thalamic volume was extracted from 84 early MRI scans at postmenstrual age of 32.33 (± 2.63) weeks and 93 term-equivalent age MRI scans at postmenstrual age of 42.05 (± 3.33) weeks of 116 very preterm infants (56% male) with gestational age at birth of 29.32 (± 2.28) weeks and a birth weight of 1158.92 (± 348.59) grams. Cognitive, motor, and language outcomes at two years of age were assessed with Bayley Scales of Infant and Toddler Development Third Edition. Bivariate analysis was used to describe the clinical variables according to neurodevelopmental outcomes and multilevel linear regression models were used to examine the impact of these variables on thalamic volume and its relationship with neurodevelopmental outcomes.

Results

The results suggest an association between severe brain injury and thalamic growth trajectory (β coef = -0.611; p < 0.001). Moreover, thalamic growth trajectory during early postnatal life was associated with the three subscale scores of the neurodevelopmental assessment (cognitive: β coef = 6.297; p = 0.004; motor: β coef = 7.283; p = 0.001; language: β coeficient = 9.053; p = 0.002).

Discussion

These findings highlight (i) the impact of severe brain injury on thalamic growth trajectory during early extrauterine life after preterm birth and (ii) the relationship of thalamic growth trajectory with cognitive, motor, and language outcomes.

Extremely Preterm Infants with a Near-total Absence of Cerebellum: Usefulness of Quantitative Magnetic Resonance in Predicting the Motor Outcome

This study aims to evaluate in extremely premature infants the severity of brain structural injury causing total absence or near-total absence of cerebellar hemispheres by using MRI visual and volumetric scoring systems. It also aims to assess the role of the score systems in predicting motor outcome. We developed qualitative and quantitative MRI scoring systems to grade the overall brain damage severity in 16 infants with total absence or near-total absence of cerebellar hemispheres. The qualitative scoring system assessed the severity of macrostructural abnormalities of cerebellum, brainstem, supratentorial gray and white matters, ventricles while the quantitative scoring system weighted the loss of brain tissue volumes, and gross motor function classification system (GMFCS) was used to assess motor function at 1- and 5-year follow-ups.Positive correlations between both MRI scores and GMFCS scales were detected at follow-ups (p > 0.05), but only the volumetric score could identify those infants developing higher levels of motor impairment.Brain volumetric MRI offers an unbiassed assessment of prenatal brain damage. The quantitative scoring system, performed at term equivalent age, can be a helpful tool for predicting the long-term motor outcome in extremely preterm infants with a near-total absence of cerebellum.

Association of brain functional connectivity with neurodevelopmental outcomes in healthy full-term newborns

OBJECTIVE

To study the association between neurodevelopmental outcomes and functional brain connectivity (FBC) in healthy term infants.

METHODS

This is a retrospective study of prospectively collected High-density electroencephalography (HD-EEG) from newborns within 72 hours from birth. Developmental assessments were performed at two years of age using the Bayley Scales of Infant Development-III (BSID-III) measuring cognitive, language, motor, and socio-emotional scores. The FBC was calculated using phase synchronization analysis of source signals in delta, theta, alpha, beta, and gamma frequency bands and its association with neurodevelopmental score was assessed with stepwise regression.

RESULTS

47/163 had both HD-EEG and BSID-III scores. The FBC of frontal region was associated with cognitive score in the theta band (corrected p, regression coefficients range: p < 0.01, 1.66-1.735). Language scores were significantly associated with connectivity in all frequency bands, predominantly in the left hemisphere (p < 0.01, -2.74-2.40). The FBC of frontal and occipital brain regions of both hemispheres was related to motor score and socio-emotional development in theta, alpha, and gamma frequency bands (p < 0.01, -2.16-2.97).

CONCLUSIONS

Functional connectivity of higher-order processing is already present at term age.

SIGNIFICANCE

The FBC might be used to guide interventions for optimizing subsequent neurodevelopment even in low-risk newborns.

Use of the Motor Optimality Score-Revised (MOS-R) to predict neurodevelopmental outcomes in infants with congenital anomalies

AIMS

To describe the Motor Optimality Score-Revised (MOS-R) in infants with congenital anomalies requiring major surgery in the neonatal period; and to determine the predictive validity of the MOS-R, including specific movement and postural patterns, for neurodevelopmental outcomes at 3 years of age.

METHOD

A retrospective cohort study of 201 infants born with congenital anomalies requiring surgery in the neonatal period (mean gestational age 38.2 weeks, SD 2.2). MOS-R completed using the pre-recorded General Movements Assessment (GMA) videos taken at 12 to 14 weeks post-term age (mean 12.45, SD 1.54). Developmental outcomes were assessed at 3 years of age (38.13 months, SD 1.76) using the Bayley Scales of Infant and Toddler Development (3rd ed).

RESULT

The mean score for the MOS-R was 21.85 (SD 5.16), with scores ranging from 6 to 28. Fifty-six infants (27.9 %) scored within the optimal range (25-28) with only 12 % demonstrating a normal movement character. A MOS-R total score of <21 was identified as the best performing cut-off to predict a mild, moderate or severe delay or CP diagnosis with sensitivity 0.39 (95 % CI: 0.25, 0.54) and specificity 0.86 (95 % CI: 0.80, 0.91), and an area under the ROC curve of 0.63. Outcome at 3 years was significantly associated with the MOS-R total (p < 0.01) and the subscales for observed movement patterns (p < 0.01) and age adequate repertoire (p = 0.02).

CONCLUSION

The MOS-R may be an effective tool to use in addition to existing assessments to identify infants who are at risk of adverse developmental outcomes. Our study found that a MOS-R of <21 identified infants who would benefit from referral to early intervention.

Associations between mother's depressive symptoms during pregnancy and newborn's brain functional connectivity

Depression during pregnancy is common and the prevalence further increased during the COVID pandemic. Recent findings have shown potential impact of antenatal depression on children's neurodevelopment and behavior, but the underlying mechanisms are unclear. Nor is it clear whether mild depressive symptoms among pregnant women would impact the developing brain. In this study, 40 healthy pregnant women had their depressive symptoms evaluated by the Beck Depression Inventory-II at ~12, ~24, and ~36 weeks of pregnancy, and their healthy full-term newborns underwent a brain MRI without sedation including resting-state fMRI for evaluation of functional connectivity development. The relationships between functional connectivities and maternal Beck Depression Inventory-II scores were evaluated by Spearman's rank partial correlation tests using appropriate multiple comparison correction with newborn's gender and gestational age at birth controlled. Significant negative correlations were identified between neonatal brain functional connectivity and mother's Beck Depression Inventory-II scores in the third trimester, but not in the first or second trimester. Higher depressive symptoms during the third trimester of pregnancy were associated with lower neonatal brain functional connectivity in the frontal lobe and between frontal/temporal lobe and occipital lobe, indicating a potential impact of maternal depressive symptoms on offspring brain development, even in the absence of clinical depression.

Prenatal exposure to air pollution is associated with structural changes in the neonatal brain

BACKGROUND

Prenatal exposure to air pollution is associated with adverse neurologic consequences in childhood. However, the relationship between in utero exposure to air pollution and neonatal brain development is unclear.

METHODS

We modelled maternal exposure to nitrogen dioxide (NO2) and particulate matter (PM2.5 and PM10) at postcode level between date of conception to date of birth and studied the effect of prenatal air pollution exposure on neonatal brain morphology in 469 (207 male) healthy neonates, with gestational age of ≥36 weeks. Infants underwent MR neuroimaging at 3 Tesla at 41.29 (36.71-45.14) weeks post-menstrual age (PMA) as part of the developing human connectome project (dHCP). Single pollutant linear regression and canonical correlation analysis (CCA) were performed to assess the relationship between air pollution and brain morphology, adjusting for confounders and correcting for false discovery rate.

RESULTS

Higher exposure to PM10 and lower exposure to NO2 was strongly canonically correlated to a larger relative ventricular volume, and moderately associated with larger relative size of the cerebellum. Modest associations were detected with higher exposure to PM10 and lower exposure to NO2 and smaller relative cortical grey matter and amygdala and hippocampus, and larger relaive brainstem and extracerebral CSF volume. No associations were found with white matter or deep grey nuclei volume.

CONCLUSIONS

Our findings show that prenatal exposure to air pollution is associated with altered brain morphometry in the neonatal period, albeit with opposing results for NO2 and PM10. This finding provides further evidence that reducing levels of maternal exposure to particulate matter during pregnancy should be a public health priority and highlights the importance of understanding the impacts of air pollution on this critical development window.