Published online October 26, 2009
PEDIATRICS Vol. 124 No. 5 November 2009, pp. e964-e972 (doi:10.1542/peds.2008-3801)
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ARTICLE

Structural Correlates of Preterm Birth in the Adolescent Brain

Zoltan Nagy, MSca,b, John Ashburner, PhDb, Jesper Andersson, PhDc, Saad Jbabdi, PhDd, Bogdan Draganski, MDb, Stefan Skare, PhDc, Birgitta Böhm, PhDe, Ann-Charlotte Smedler, PhDf, Hans Forssberg, MD, PhDe and Hugo Lagercrantz, MD, PhDa

a Neonatal
e Neuropediatric Units, Department of Woman and Child Health
c Magnetic Resonance Center, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
b Wellcome Trust Center for Neuroimaging, Institute of Neurology, University College London, London, England
d Centre for Functional Magnetic Resonance Imaging of the Brain, Department of Clinical Neurology, University of Oxford, Oxford, England
f Department of Psychology, University of Stockholm, Stockholm, Sweden

OBJECTIVE: The Stockholm Neonatal Project involves a prospective, cross-sectional, population-based, cohort monitored for 12 to 17 years after birth; it was started with the aim of investigating the long-term structural correlates of preterm birth and comparing findings with reports on similar cohorts.

METHODS: High-resolution anatomic and diffusion tensor imaging data measuring diffusion in 30 directions were collected by using a 1.5-T MRI scanner. A total of 143 adolescents (12.18–17.7 years of age) participated in the study, including 74 formerly preterm infants with birth weights of ≤1500 g (range: 645–1486 g) and 69 term control subjects. The 2 groups were well matched with respect to demographic and socioeconomic data. The anatomic MRI data were used for calculation of total brain volumes and voxelwise comparison of gray matter (GM) volumes. The diffusion tensor imaging data were used for voxelwise comparison of white matter (WM) microstructural integrity.

RESULTS: The formerly preterm individuals possessed 8.8% smaller GM volume and 9.4% smaller WM volume. The GM and WM volumes of individuals depended on gestational age and birth weight. The reduction in GM could be attributed bilaterally to the temporal lobes, central, prefrontal, orbitofrontal, and parietal cortices, caudate nuclei, hippocampi, and thalami. Lower fractional anisotropy was observed in the posterior corpus callosum, fornix, and external capsules.

CONCLUSIONS: Although preterm birth was found to be a risk factor regarding long-term structural brain development, the outcome was milder than in previous reports. This may be attributable to differences in social structure and neonatal care practices.

Key Words: preterm • magnetic resonance imaging • brain • diffusion tensor imaging • follow-up evaluation

Abbreviations: BW—birth weight • DTI—diffusion tensor imaging • WM—white matter • GM—gray matter • FA—fractional anisotropy • GA—gestational age • GMV—grey matter volume • SGA—small for gestational age • TBV—total brain volume • WMV—white matter volume

Accepted Jun 4, 2009.


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