658 - Neurodevelopmental Profiles of Preterm Born Children at 4–6 Years and Their Association with Neonatal Clinical Factors: A Latent Profile Analysis

Publication Number: 2641.658

Eleanor J G. Brian, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Steven Ufkes, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Ting Guo, The Hospital for Sick Children, Toronto, ON, Canada; Jessie van Dyk, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Vann Chau, The Hospital for Sick Children, Toronto, ON, Canada; Helen Branson, The Hospital for Sick Children, Toronto, ON, Canada; Linh G. Ly, The Hospital for Sick Children, Toronto, ON, Canada; Edmond N. Kelly, University of Toronto Temerty Faculty of Medicine, 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: Children born preterm show variability in motor, visuomotor, and cognitive functioning; however, the factors associated with different developmental trajectories remain poorly understood. Identifying cross-domain patterns of impairment, rather than relying on single test thresholds, may better detect developmental phenotypes – Latent profile analysis (LPA) can be applied to capture these phenotypes.

Objective: Using LPA to identify distinct neurodevelopmental profiles among children aged 4–6 years born preterm, we hypothesized that neonatal clinical variables would predict LPA-derived profile membership.

Design/Methods: LPA was performed using: WPPSI-IV Full-Scale IQ, Beery–Buktenica Visual-Motor Integration (VMI), two BRIEF subscales (inhibition, working memory) and three Movement ABC subtests (manual dexterity, aiming & catching, balance) at age 4-6y. Model fit indices supported a four-class solution (AIC=2851.6; BIC=2967.8; Entropy=0.83). Neonatal MRI scans were assessed for significant brain injury, defined as intraventricular hemorrhage grade 3–4, white-matter injury >40 mm³, arterial ischemic stroke, and/or cerebellar hemorrhage >39mm³.

Results: The cohort included 157 children born between 22–31 weeks’ gestation (53% male). LPA analyses highlighted four distinct profiles (see Table 1). Significant brain injury was present in 14% of the sample and was more prevalent in the global high impairment profile (29%) compared to other profiles (11–13%). These children also had greater neonatal illness severity, including higher SNAP-II scores (p < 0.001), more days on mechanical ventilation (p=0.03), and longer fentanyl exposure (p=0.03), compared to the low impairment profile. A multinomial logistic regression highlighted male sex was strongly associated with higher-impairment profiles compared to low-impairment profile (executive function impairment: β=1.79, p< 0.001, OR=6.01; Motor/VMI/IQ impairment: β=2.12, p< 0.001, OR=8.36; High impairment: β=2.85, p< 0.001, OR=17.3). Lower maternal education (β=−1.3, p=0.03, OR=0.27) and greater neonatal pain exposure (β=2.11, p< 0.001, OR=8.3) predicted membership in the global high impairment profile compared to the low impairment profile.

Conclusion(s): LPA can be used to identify distinct neurodevelopmental profiles among preterm-born children. Male sex, lower maternal education, and greater neonatal pain exposure predicted high impairment profile membership. Future analyses will use neonatal diffusion MRI to examine whether white-matter microstructure further refines prediction of neurodevelopmental profile membership.

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