Associations of brain MRI and perinatal factors with 2-year neurodevelopment in very preterm infants

BACKGROUND: Neonatal magnetic resonance imaging (MRI) is essential for identifying brain injuries, dysmaturation and understanding neurodevelopment in preterm infants. This study aimed to evaluate the associations between qualitative and quantitative neonatal brain MRI findings, alongside perinatal clinical variables, with neurodevelopmental outcomes across cognitive, language, and motor domains at 2 years' corrected age in preterm infants. METHODS: Retrospective cohort study of 50 very preterm infants (<32 weeks) who underwent brain MRI scans at term-equivalent age. MRI assessment included Kidokoro scores, morphometric measurements (biometric and volumetric), and apparent diffusion coefficients. Neurodevelopmental outcomes were assessed using the Bayley Scales of Infant and Toddler Development, 3rd edition. Correlations and regression analysis were used to evaluate associations with neurodevelopmental outcomes. RESULTS: Multivariable models explained a substantial variance in cognitive (51.5%), language (32.3%), and motor (37.9%) outcomes. The Kidokoro deep grey matter (DGM) score emerged as the most consistent independent factor associated with all three domains. Additional factors linked to cognitive outcomes included DGM area and biparietal diameter, while DGM area was associated with language outcomes, and the 10-min Apgar score with motor outcomes. Both DGM and white matter Kidokoro scores were significantly associated with the likelihood of neurodevelopmental impairment classification. CONCLUSIONS: Combining neonatal brain MRI assessments with perinatal clinical data correlates with neurodevelopmental outcomes at 2 years' corrected age. Reduced or abnormal DGM is associated with altered cerebral development across multiple domains, suggesting it is a relevant marker of early neurodevelopmental status in very preterm infants.