Early White Matter Diffusivity Predicts Language Development at 18 Months in Neonates with Hypoxic Ischemic Encephalopathy
Marina Solti1, Pei-Yi Lin1, Jason Sutin1, Christina Lildharrie1, Rutvi Vyas1, Lara J. Pierce2, Mohamed El-Dib3, Sarah U. Morton1, Fan Zhang3, Lauren J. O'Donnell3, Yogesh Rathi3, Charles A. Nelson1, Janet S. Soul1, Terrie E. Inder3, P. Ellen Grant1, Banu Ahtam1
1Boston Children's Hospital, 2York University, 3Brigham and Women’s Hospital
Objective:
In neonates with HIE, determine the ability of white matter microstructure within the first week after birth to predict neurodevelopmental outcomes at 18 months.
Background:
The relationship between diffusion metrics in the first week after birth in neonates with HIE and later neurodevelopmental outcomes is not fully understood.
Design/Methods:
19 newborns (10 males) with HIE who underwent therapeutic hypothermia, had 3T MRI studies at mean age 3.84±0.98 days after birth (NE-score 4.53±2.13). Bayley Scales of Infant and Toddler Development (BSID-III) was performed at ~18 months. Unscented Kalman filter tractography and white matter analysis pipeline were used to automatically extract corpus callosum (CC), bilateral corticospinal tract (CST) and inferior fronto-occipital fasciculus (IFOF). Using SPSS, linear regression analysis was conducted with BSID-III outcome scores (cognitive, language and motor composites) and diffusivity metrics of each tract (fractional anisotropy, mean, axial, and radial diffusivity), controlling for age at scan, sex, gestational age, birthweight, MRI scan site, MRI scanner model, number of scanner head coil elements, and whole brain volume.
Results:
FA (p=0.017; β=-0.778, Adjusted-R²=0.931), MD (p=0.040; β=0.767, Adjusted-R²=0.875), and RD (p=0.031; β=0.719, Adjusted-R²=0.895) values of the left IFOF during the first week after birth correlated with BSID-III language scores (mean 104.84±13.78) at age 18 months. No significant correlation was found between right IFOF, CC or bilateral CST with any of the composite scores of BSID-III.
Conclusions:
In HIE patients, altered left IFOF white matter microstructure in the week after birth correlated with language outcome at 18 months. The left IFOF is involved in semantic processing and is part of the ventral language network. Diffusivity metrics show potential as early biomarkers for language skills and identification of infants in need of targeted interventions to optimize language outcomes.
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