Association between neonatal brain volume and school-age executive function in children born moderate-to-late preterm.

BACKGROUND

Larger brain volumes in the neonatal period are associated with better 2-year cognitive development in children born moderate-to-late preterm (MLP). Whether these associations persist into school age for executive function (EF) is unknown.

METHODS

Children born MLP underwent brain magnetic resonance imaging (MRI) at term-equivalent age (n = 168) and EF assessment at 9 years (n = 159). Mean or median differences in EF subdomains (attentional control, cognitive flexibility, goal setting, behavioral EF) for a unit increase in brain volumes were estimated using linear regression, overall and for subgroups defined by gestational age at MRI, sex and excluding participants with developmental delay at 2 years.

RESULTS

There were few associations between brain volumes and EF. Small effects were found for larger total tissue (mean difference = 0.16; 95% CI = -0.04, 0.36; p = 0.11), white matter (mean difference = 0.21; 95% CI = 0.05, 0.38; p = 0.01) and subcortical gray matter (mean difference = 0.17; 95% CI = -0.01, 0.34; p = 0.06) volumes and improved goal setting. Subgroup relationships were similar.

CONCLUSION

Neonatal brain volumes in MLP children are not strongly associated with school-age EF. Imaging techniques with higher sensitivity, and other risk factors for poorer EF should be explored.

IMPACT: This study described the associations between neonatal brain volumes and executive function (EF) outcomes at 9 years in children born moderate-to-late preterm (MLP), a group that has been under researched compared with children born very preterm. There was limited evidence of an association between neonatal brain volumes and school-age EF outcomes in children born MLP, contrasting previous findings in very preterm children. This suggests that neonatal brain volumes alone do not effectively predict school-age EF in children born MLP, highlighting the need for more sensitive neuroimaging techniques and identification of other important predictors of long-term outcomes in this population.