Anterior Cingulate and Frontal Lobe White Matter Spectroscopy in Early Childhood of Former Very LBW Premature Infants

Neurometabolic sequelae of children born at very LBW (VLBW) are not well characterized in early childhood. Proton magnetic resonance spectroscopy (1H-MRS) and developmental assessments were acquired from children age 18–22 mo (16 VLBW/7 term) and 3–4 y (12 VLBW/8 term) from the anterior cingulate and left frontal periventricular white matter. Metabolites obtained included combined N -acetylaspartylglutamate and N -acetylaspartate (NAA), total choline-containing compounds (Cho), combined glutamate and glutamine (Glx), combined creatine and phosphocreatine (Cr), myoinositol (mI), and the following ratios: NAA/Cr, Cho/Cr, Glx/Cr, mI/Cr, and NAA/Cho. Significant differences were present only in white matter: at 18–22 mo, NAA was decreased in VLBW children ( p < 0.04), and at 3–4 y, VLBW children showed lower Cr ( p < 0.01), lower NAA/Cho ( p < 0.005), higher Glx/Cr ( p < 0.02), and higher Cho/Cr ( p < 0.005). On developmental testing, VLBW children scored lower on language expression ( p < 0.05) and on the A-not-B test of early executive function ( p < 0.01) at 18–22 mo and had lower verbal intelligence quotient (IQ) ( p < 0.005), performance IQ ( p < 0.04), and several measures of early executive function including the bear-dragon test ( p < 0.004), gift delay ( p < 0.07), and summary categorization score ( p < 0.03) at 3–4 y. VLBW children may have neurometabolic and developmental abnormalities that persist at least through early childhood.