King's College London

Between 1979 and 1984, 473 infants who were born before 33 weeks’ gestation were admitted consecutively to the neonatal unit of UCHL in the first five days after birth. They were the first series of very preterm infants to have neonatal ultrasound brain scanning performed, using relatively crude linear array apparatus. The study was initiated by Dr Ann Stewart and Prof John Wyatt.

Those infants who survived and were discharged were invited to take part in a follow-up study and were reassessed periodically throughout their lives. Assessments of neurological, behavioural and cognitive outcomes of these children were done at 1, 4, 8 years. When participants reached the age of 14-15 years, the study moved to the Institute of Psychiatry, Psychology and Neuroscience (previously Institute of Psychiatry) under the leadership of Prof Sir Robin Murray, and multi-modal Magnetic Resonance Imaging was added to the assessment battery.

The latest assessment was conducted when participants were 30 years old under the leadership of Prof Chiara Nosarti. At each timepoint, age and sex-matched term-born controls were recruited from the community.

The UCHL study has shown that the young brain is enormously resilient to injury, as functional impairments seen in individuals who were born preterm are relatively mild compared to the structural brain alterations that they display. These findings suggest that processes of neuroplasticity are helping the brain to adapt to the neurodevelopmental alterations associated with preterm birth.

Key findings from the follow-up at 30 years

• Novel structure-function associations develop following very preterm birth. These results can inform how specific functions could be boosted by exploiting the brain’s intrinsic means of compensating for preterm-related functional and structural brain alterations.
  
  
• The way learning takes place differs between individuals who were born very preterm and controls. This could reflect suboptimal learning strategies and underlie low academic success. An increased understanding of the links between education and neuroscience could help addressing the educational needs of preterm children and improving their learning outcomes.
  
  
• Perinatal brain injury is associated with reduced pre-synaptic dopamine synthesis capacity in the striatum in adulthood. These findings represent novel insight into the neurochemical basis for cognitive impairments and vulnerability to psychiatric disorders associated with very preterm birth.
  
  
• Successful development of connections is crucial to typical brain functioning and atypical development can lead to a range of cognitive and psychiatric issues in adult life.
  
  
• Infants born very preterm show accelerated brain development in adult life, as their brains look ‘older’ compared to their contemporaries who were born at term.

The project team members are:

Chiara Nosarti
Robin Murray
Vjaceslavs Karolis
Seán Froudist Walsh
Philip Brittain
Jasmin Kroll
Jane Tseng

Funded by: Medical Research Council
Ethical Clearance Reference Number: PNM/12/13-10