Steven Miller

Children born very preterm exhibit neurodevelopmental problems, compared to term-born peers. Math underperformance is particularly evident and is associated with poorer visuospatial skills. Neonatal exposure to repeated invasive procedures during neonatal intensive care unit (NICU) stay that induce pain and stress has been identified as one contributing factor to poorer cognitive performance, but relationships with mathematics achievement have not been studied.Partial least squares correlation (PLSC) analyses were performed to investigate whether:1. Neonatal pain-related stress and clinical factors are related to math skills at age 8 years, and whether: a) maternal education, b) white matter injury, and c) child sex, contribute to the relationship.2. Neonatal pain-related stress and clinical factors are related to functional network activation during visuospatial processing.3. Functional network activation during visuospatial processing is related to math skills.In an ongoing prospective longitudinal cohort study, N=118 (63 male) children born very preterm at 8 years underwent neuropsychological and math skills assessment, and N=75 children also completed a visuospatial mental rotation of hands task. Prospective daily clinical chart review conducted across the NICU stay recorded pain/stress (number of invasive procedures) and clinical factors. No child with major brain injury and/or severe motor, sensory, or cognitive impairments was included. I found that:1. Greater pain/stress exposure was related to poorer math skills, along with morphine, gestational age, ventilation, and infection (τ=80%, p<.001 none="" of="" maternal="" education="" white="" matter="" injury="" or="" child="" sex="" contributed="" to="" the="" relationship.2.="" greater="" neonatal="" pain="" morphine="" ventilation="" snap-ii="" infection="" and="" lower="" gestational="" age="" were="" then="" related="" increased="" brain="" network="" activation="" that="" included="" right="" superior="" parietal="" lateral="" occipital="" left="" inferior="" temporal="" cortices="" p="" poorer="" scores="" in="" all="" math="" domains="" including="" bilaterally="" with="" concomitant="" decreased="" cortex="" this="" study="" suggests="" a="" link="" via="" visuospatial="" processing="" between="" supports="" importance="" abilities="" relation="" performance="" for="" children="" born="" very="" preterm.="">
View record

Altered hippocampal morphology and reduced volumes have been found in children born preterm compared to full-term. Stress inhibits neurogenesis in the hippocampus, and neonatal stress/noxious stimulation in rodent pups are associated with long-term alterations in hippocampal volumes. We have previously shown reduced cortical thickness and cerebellar volumes in relation to more exposure to pain-related stress of neonatal invasive procedures in children born very preterm. We have reported targeted gene-by-pain environment interactions that contribute to long-term brain development and outcomes in this population. We now aim to determine whether exposure to neonatal pain-related stress (adjusted for clinical factors) deferentially impacts regional structures within the limbic system and thalamus and investigate relationships with outcomes in very preterm children. Our study included 57 children born very preterm (
View record