Associations of Bronchopulmonary Dysplasia and Infection with School-Age Brain Development in Children Born Preterm.

OBJECTIVE

To determine the association of bronchopulmonary dysplasia (BPD) and culture-positive infection with neurodevelopment and white matter maturation at 8 years of age in children born preterm.

STUDY

DESIGN

Prospective cohort study of 164 children born at 24-32 weeks of gestation followed to 8 years of age (89 male, median [IQR] age: 8.24 [8.07-8.58] years). At age 8, IQ (Weschler Abbreviated Scale of Intelligence, second Ed), working memory (Wechsler Intelligence Scale for Children, fifth Ed), visual-motor (Beery-Buktenica Developmental Test of Visual-Motor Integration sixth Ed), and motor outcomes (Movement Assessment Battery for Children-2) were assessed. Diffusion tensor imaging and tract-based spatial statistics were used to assess fractional anisotropy (FA).

RESULTS

Fifty of 164 children had BPD and 72/164 had culture-positive infection. At 8 years, BPD was associated with a 9.8-point decrease in motor (CI -17.9 to -1.8, P = .02) and 6.0-point decrease in visual-motor scores (CI -10.5 to -1.5, P = .009), whereas infection was associated with a 6.3-point decrease in IQ (CI -12.3 to -0.3, P = .04), after adjusting for gestational age and white matter injury volume. BPD was associated with left hemisphere-dominant FA reductions, which were associated with worse motor (P = .000006) and visual-motor (P = .00005) outcomes, whereas infection was associated with bilateral FA reductions, which were associated with lower IQ scores (P = .03) and poorer working memory (P = .01) at 8 years.

CONCLUSIONS

This cohort study of children born very preterm suggests that BPD and culture-positive infection are distinctly associated with impaired white-matter development and poor neurodevelopmental outcomes. These findings imply neonatal illnesses impact the brain nonuniformly, suggesting opportunities for targeted intervention.