Children born prematurely are at risk for Periventricular Hemorrhage (PVH) and Periventricular Leukomalacia (PVL), lesions which lead to unilateral and multi-focal white matter damage, respectively. Children with PVH and PVL are at risk for neurodevelopmental disabilities. The goal of this study is to relate the degree and patterns of white matter damage from PVH and PVL to linguistic and cognitive outcomes. Two sophisticated MRI procedures will complement behavioral testing. Diffusion Tensor Imaging (DTI) provides detailed voxel-based quantitative information on the integrity of white matter microstructure;functional Magnetic Resonance Imaging (fMRI) characterizes the patterns of neural activity underlying cognitive skills. fMRI tasks will assess domains known to be supported in mature functioning by widely distributed brain circuitry that may be impaired after white matter injury-comprehension of syntactically complex sentences, which relies on interhemispheric integration, and oculomotor response inhibition and spatial working memory, which rely on occipital-frontal and cortical-subcortical integration. The combination of methods will allow us to link brain structure, brain functioning, and behavioral outcomes. Participants will be 40 adolescents, 9 to 14 years old, with PVH or PVL from preterm delivery. Two control groups (children born prematurely and children born at term) matched for age, gender and socioeconomic status (SES) will clarify the contribution of white matter damage versus other influences, such as age and premature delivery, on outcomes. Regression analyses will evaluate the associations of global and track-specific white matter damage and behavioral outcomes. Models will also consider the contributions of age, gender, SES, and extent of gray matter injury to white matter integrity and outcomes. Patterns of activation on fMRI will be evaluated in relation to the extent and pattern of white matter damage and to scores on the behavioral measures. We will identify cases that reveal important relations between neural structure and function. This study will contribute to understanding the outcomes of PVH and PVL, an important issue because of the large number of affected infants. It will contribute to understanding the importance of white matter connections in the normal development of cognitive processes. It will also contribute to understanding the impact of white matter injury and the development of cortical plasticity after early brain injuries.
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