Brain Injury and Pain Exposure are Associated with Alterations in Structural Connectivity and Neurodevelopment in Very Preterm Infants
Bibliographic record
Abstract
Preterm infants undergo neonatal intensive care during a period of maturation of structural brain networks, which may be affected by clinical illness and exposures such as brain injury and pain. This thesis explores (1) the impacts of brain injury and pain on development of structural connectivity and neurodevelopmental outcomes, and (2) whether aberrations in structural connectivity are an important mediator of outcomes. A prospective cohort of very preterm infants underwent early-life and term-equivalent age brain MRI to assess brain injury and structural connectivity. Exposure to pain was quantified as number of invasive procedures. Neurodevelopmental outcomes were assessed at 18 months corrected age with the Bayley Scales of Infant and Toddler Development, Third edition. Brain injuries were segmented to quantify volumes and develop voxel-wise lesion-symptom maps to assess relationships between brain injury size and location with neurodevelopmental outcomes. These data were combined with data of structural connectivity to develop voxel-wise disconnection-symptom maps that assessed relationships between brain injury size and location with aberrations in structural connectivity and neurodevelopmental outcomes. These maps revealed that brain injury involving tracts passing through the basal ganglia, thalamus and pons were associated with poorer neurodevelopmental outcomes. This highlights the importance of considering brain injury relative to white matter tracts when predicting neurodevelopmental outcomes. Greater early-life pain was associated with poorer neurodevelopmental outcomes, and potentially mediated by alterations in neonatal structural connectivity. Specifically, greater invasive procedures were associated with widespread reductions in structural brain connectivity, and reduced connectivity was associated with poorer neurodevelopmental outcomes with specificity for the striatum. The relationship between greater early-life pain and adverse neurodevelopmental outcomes was modified by duration of morphine exposure. However, morphine exposure was not associated with neonatal structural connectivity suggesting that morphine may modify neurodevelopmental outcomes through alternative mechanisms. Finally, associations observed between pain and brain injury, aberrant connectivity within the striatum, and neurodevelopmental outcomes highlight a potential vulnerability of this region to clinical illness and exposures during early brain development in very preterm infants. These data also suggest that the striatum may play an important role in neurodevelopment in this population; this warrants further study.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".