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Early pain/stress and math skills in relation to fMRI during visuospatial processing at age 8 years in children born very preterm Phillips, Hannah Cameron


Children born very preterm exhibit neurodevelopmental problems, compared to term-born peers. Math underperformance is particularly evident and is associated with poorer visuospatial skills. Neonatal exposure to repeated invasive procedures during neonatal intensive care unit (NICU) stay that induce pain and stress has been identified as one contributing factor to poorer cognitive performance, but relationships with mathematics achievement have not been studied. Partial least squares correlation (PLSC) analyses were performed to investigate whether: 1. Neonatal pain-related stress and clinical factors are related to math skills at age 8 years, and whether: a) maternal education, b) white matter injury, and c) child sex, contribute to the relationship. 2. Neonatal pain-related stress and clinical factors are related to functional network activation during visuospatial processing. 3. Functional network activation during visuospatial processing is related to math skills. In an ongoing prospective longitudinal cohort study, N=118 (63 male) children born very preterm at 8 years underwent neuropsychological and math skills assessment, and N=75 children also completed a visuospatial mental rotation of hands task. Prospective daily clinical chart review conducted across the NICU stay recorded pain/stress (number of invasive procedures) and clinical factors. No child with major brain injury and/or severe motor, sensory, or cognitive impairments was included. I found that: 1. Greater pain/stress exposure was related to poorer math skills, along with morphine, gestational age, ventilation, and infection (τ=80%, p<.001). None of maternal education, white matter injury, or child sex contributed to the relationship. 2. Greater neonatal pain/stress, morphine, ventilation, SNAP-II, infection, and lower gestational age were then related to increased brain network activation that included the right superior parietal, right lateral occipital, and left inferior temporal cortices (τ=65%, p<.001). 3. Poorer scores in all math domains were related to increased activation including in the superior parietal and lateral occipital cortices bilaterally and with concomitant decreased activation that included the right inferior parietal cortex (τ=93%, p<.001). Overall this study suggests a link via visuospatial processing between math and pain/stress and supports the importance of visuospatial abilities in relation to math performance for children born very preterm.

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