Proper timing for the evaluation of neonatal brain white matter development: a diffusion tensor imaging study
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We aimed to determine the timing for assessing birth status of the developing brain (i.e. brain maturity at birth) by exploring the postnatal age-related changes in neonatal brain white matter (WM).
The institutional review board approved this study and all informed parental consents were obtained. 133 neonates (gestational age, 30–42 weeks) without abnormalities on MRI were studied with regard to WM development by diffusion tensor imaging-derived fractional anisotropy (FA). Tract-based spatial statistics (TBSS), locally-weighted scatterplot smoothing (LOESS) and piecewise linear-fitting were used to investigate the relationship between FA and postnatal age. FA along corticospinal tract (CST), optic radiation (OR), auditory radiation (AR) and thalamus-primary somatosensory cortex (thal-PSC) were extracted by automated fibre-tract quantification; their differences and associations with neonatal neurobehavioural scores at various postnatal age ranges were analysed by Wilcoxon’s rank-sum test and Pearson’s correlation.
Using TBSS, postnatal age (days 1–28) positively correlated with FA in multiple WMs, including CST, OR, AR and thal-PSC (p<0.05). On the other hand, when narrowing the postnatal age window to days 1–14, no significant correlation was found, suggesting a biphasic WM development. LOESS and piecewise linear-fitting indicated that FA increased mildly before day 14 and its growth accelerated thereafter. Both FA and correlations with neurobehavioural scores in postnatal age range 2 (days 15–28) were significantly higher than in range 1 (days 1–14) (FA comparison: p<0.05; maximal correlation-coefficient: 0.693 vs. 0.169).
Brain WM development during the neonatal stage includes two phases, i.e. a close-to-birth period within the first 14 days and a following accelerated maturation period. Therefore, evaluations of birth status should preferably be performed during the first period.
• Brain white matter development within the first two postnatal weeks resembles a close-to-birth maturation.
• Brain white matter development in the audio-visual, sensorimotor regions accelerates after two postnatal weeks.
• Postnatal age-related effects should be considered in comparing preterm and term neonates.
KeywordsNewborn White matter Child development Diffusion tensor imaging
Diffusion tensor imaging
Locally-weighted scatterplot smoothing
- MR imaging
Magnetic resonance imaging
Tract-based spatial statistics
Thalamus-primary somatosensory cortex
This study has received funding by the National Key Research and Development Program of China (2016YFC0100300), National Natural Science Foundation of China (No. 81171317, 81471631, 81771810 and 51706178), the 2011 New Century Excellent Talent Support Plan of the Ministry of Education, China (NCET-11-0438), China Postdoctoral Science Foundation (No. 2017M613145), Shaanxi Provincial Natural Science Foundation for Youths of China (No. 2017JQ8005), the Clinical Research Award of the First Affiliated Hospital of Xi’an Jiaotong University (No. XJTU1AF-CRF-2015-004) and the Hospital Fund of the First Affiliated Hospital of Xi’an Jiaotong University, China (No. 2016QN-08).
Compliance with ethical standards
The scientific guarantor of this publication is Jian Yang, the First Affiliated Hospital of Xi'an Jiaotong University
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
• Performed at one institution
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