A cortical signature of very preterm birth across development and its association with neurodevelopmental outcomes

Abstract

Gestational age (GA) is a key determinant of neurodevelopment, and individuals born very preterm (VPT; [≤] 32 weeks' gestation) are at increased risk of cognitive and behavioural difficulties across the lifespan. A better understanding of the impact of VPT birth on cortical maturation trajectories may provide mechanistic insight into the origins of these neurodevelopmental sequelae. Here we compared cortical morphology between VPT individuals and full-term controls in three datasets spanning the neonatal period, childhood and adulthood. We identified a consistent cortical signature of VPT birth, characterized by reduced surface area and cortical folding in the frontal, temporal, parietal and insular regions, which were observed across development. Reduced surface area and cortical folding in the neonatal period were associated with clinical factors and poorer motor outcomes in toddlerhood. Furthermore, longitudinal analyses in a VPT cohort showed that greater cortical expansion from the neonatal period to childhood was associated with higher childhood IQ. Together, these findings demonstrate persistent cortical morphological alterations following VPT birth and their relevance to long-term neurodevelopmental outcomes.