NEURODEVELOPMENTAL OUTCOMES IN PRETERM INFANTS: A MULTICENTER LONGITUDINAL COHORT STUDY

Abstract

Background: Improved survival of preterm infants has shifted clinical focus toward long-term neurodevelopmental outcomes, which remain highly variable and incompletely understood.Objective: To longitudinally evaluate neurodevelopmental trajectories in preterm infants across multiple developmental domains and to identify perinatal and neural correlates of adverse outcomes.Methods: This multicenter longitudinal cohort study followed preterm infants from infancy through school age using repeated standardized assessments of cognitive, motor, language, and behavioral development, complemented by advanced neuroimaging measures of brain structure and connectivity. Longitudinal mixed-effects models were applied to examine developmental trajectories and their associations with perinatal risk factors and neuroimaging markers.Results: The findings revealed heterogeneous and evolving neurodevelopmental trajectories across domains. Cognitive, motor, and language outcomes demonstrated differential growth patterns over time, while behavioral and executive function impairments frequently emerged at later ages. Lower gestational age, reduced birth weight, and increased neonatal morbidity were significantly associated with less favorable trajectories. Neuroimaging analyses showed that disruptions in structural and functional brain connectivity were strongly linked to both the presence and severity of neurodevelopmental impairments. Composite impairment analyses highlighted the frequent co-occurrence of deficits across domains, emphasizing the multifactorial nature of developmental vulnerability in preterm infants.Conclusions: Neurodevelopment following preterm birth is dynamic and shaped by interacting perinatal, neural, and environmental factors across childhood. Long-term, multimodal follow-up is essential to accurately identify persistent and emerging impairments. Early neuroimaging biomarkers and longitudinal assessments may enhance risk stratification and guide timely, individualized interventions to improve long-term outcomes.