Oral Presentation 46th Annual Meeting of the Fetal and Neonatal Physiological Society 2019

Increased risk of anxiety in early adolescence following very preterm birth: role of prefrontal and limbic brain region development (#25)

Courtney Gilchrist 1 2 3 , Deanne Thompson 2 3 , Angela Cumberland 1 , Mary Tolcos 1 , Bonnie Alexander 2 3 , Claire Kelly 2 3 , Karli Treyvaud 2 , Lilian Matthews 2 4 , Jeanie Cheong 2 5 6 , Terrie Inder 2 4 , Lex W Doyle 2 5 6 7 , Peter Anderson 2 8
  1. Neurodevelopment in Health & Disease Program, School of Health & Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
  2. Victorian Infant Brain Study (VIBeS), Murdoch Children's Research Institute, Parkville, Victoria, Australia
  3. Developmental Imaging, Murdoch Children's Research Institute, Parkville, Victoria, Australia
  4. Department of Pediatric Newborn Medicine, Brigham and Women's Hosptial, Harvard Medical School, Boston, USA
  5. Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
  6. Newborn Research, Royal Women's Hospital, Parkville, Victoria, Australia
  7. Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
  8. Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia

BACKGROUND: Anxiety disorders are the most common mental health condition in Australia and have profound social and economic costs. Children, adolescents and young adults born very preterm (VPT; <32 weeks) display increased rates of anxiety compared with the general population. Cross-sectional studies have found reduced volumes in limbic and prefrontal brain regions involved in emotional functioning in neonates and school-age children compared to full-terms. This study aimed to determine whether the growth trajectories of these limbic regions across childhood were associated with emotional outcomes in adolescence.

METHODS: 122 infants born VPT were recruited from the Victorian Infant Brain Study (VIBeS) cohort, with MRI scans performed at term-equivalent, 7 and 13 years of age. Structural T1- and T2-weighted images were pre-processed and parcellated into the Desikan-Killany atlas (7- and 13-year images) and corresponding M-CRIB atlas regions (neonatal images). Volumes of 18 limbic and prefrontal regions were derived at the 3 time-points for this analysis. Mental health was assessed using a structured interview (DAWBA) at the 13-year follow-up, with 16 VPT children meeting criteria for an anxiety disorder. Linear regression models were fitted to investigate associations between anxiety and each brain volume, and change in each brain volume between time-points using generalised estimating equations.

RESULTS: Anxiety disorder diagnosis at 13 years was associated with slower right hippocampus and left medial orbitofrontal region growth from 0 to 7 years. These associations persisted after adjusting for sex, total brain volume and social risk.

CONCLUSION: Our findings suggest that associations between volumes of prefrontal and limbic regions and anxiety occur in a region- and age-specific manner. Slower growth from 0 to 7 years in VPT children with anxiety highlights that early brain alterations have implications for later emotional functioning. Future analysis of connecting limbic white matter tracts will provide further clarification on current findings.