661 - Associations of neonatal ventricular volume with brain development and neurodevelopmental outcomes in children born preterm

Publication Number: 2644.661

Caroline Kim, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Steven Ufkes, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Jessie van Dyk, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Ting Guo, The Hospital for Sick Children, Toronto, ON, Canada; Vann Chau, The Hospital for Sick Children, Toronto, ON, Canada; Ruth Grunau, Unversity of British Columbia, Vancouver, BC, Canada; Steven P,.. Miller, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada

Background: Enlarged ventricular size is one of the most common brain abnormalities in infants born preterm and is often associated with concurrent brain injury. Increased ventricular volume has been identified as a risk factor for adverse neurodevelopmental outcomes into preschool-age.

Objective: To determine the associations of ventricular volume trajectory from early-life to age 8 years with school-age neurodevelopmental outcomes and cortical thickness.

Design/Methods: This prospective cohort studied 164 preterm neonates (88 [54%] male, median [IQR] gestational age [GA], 27.9 [25.9-29.9] weeks) longitudinally from birth to 8-years of age. Detailed clinical data (hypotension, infection, etc.) were collected day-by-day through the neonatal course. Structural magnetic resonance imaging (MRI) was collected at 3 time points (early-life, term-equivalent age [TEA], and 8-years of age). White matter injury (WMI) volume was quantified using MRI. Neurodevelopmental outcomes were assessed at age 8-years (8.24 [8.07-8.58] years) using the Movement Assessment Battery for Children, 2nd Edition (MABC-2), Weschler Abbreviated Scale of Intelligence, 2nd Edition full-scale IQ (IQ), and Weschler Intelligence Scale for Children, 5th Edition working memory index.
Supratentorial ventricular volume and total cerebral volume (TCV) were automatically segmented using the Multiple Automatically Generated Templates-Brain pipeline. We used the 75th percentile of the ratio of ventricular volume to TCV to define high ventricular volume ratios.

Results: We found a significant difference in the trajectory of ventricular volume ratio from early-life to TEA (β=-0.01, p<.001) and to 8-years (β=-0.02, p<.001) between normal and high ventricular volume ratio groups using linear mixed models adjusting for GA at birth, WMI volume, and IVH grade. Early-life ventricular volumes were associated with 8-year IQ scores (β=-1.1, p=.002). WMI volume significantly modified this relationship (p=.01), where the negative association between ventricular volume and IQ was accentuated by greater WMI volume. TEA ventricular volumes were associated with 8-year IQ (β=-0.8, p<.001) and MABC-2 total scores (β=-0.8, p=.001). Restricted cubic spline models fit significantly better than linear models evaluating TEA ventricular volume with right (p=.02) and left (p=.04) average cortical thickness.

Conclusion(s): In children born preterm, there is a non-linear relationship between neonatal ventricular volume and 8-year cortical thickness. This may underlie the relationship between neonatal ventricular volume with 8-year neurodevelopmental outcomes and warrants further research.

Table 1
Cohort characteristics based on early-life ventricular volume to total cerebral volume ratio.

Figure 1
Figure 1: The relationship between log of ventricular volume at TEA in cubic cm with 8-year neurodevelopmental outcomes (left: full-scale IQ, right: MABC-2 total score).

Figure 2
The relationship between ventricular volume at TEA with 8-year cortical thickness using cubic spline regression models (left: average left cortical thickness, right: average right cortical thickness).