title: Neonatal Pain and Infection Relate to Smaller Cerebellum in Very Preterm Children at School Age.
abstract: OBJECTIVE
  To examine whether specific neonatal factors differentially influence cerebellar subregional volumes and to investigate relationships between subregional volumes and outcomes in very preterm children at 7 years of age.
  
  
  METHODS
  Fifty-six children born very preterm (24-32 weeks gestational age) followed longitudinally from birth underwent 3-dimensional T(1)-weighted neuroimaging at median age 7.6 years. Children with severe brain injury were excluded. Cerebellar subregions were automatically segmented using the multiple automatically generated templates algorithm. The relation between cerebellum subregional volumes (adjusted for total brain volume and sex) and neonatal clinical factors were examined using constrained principal component analysis. Cognitive and visual-motor integration functions in relation to cerebellar volumes were also investigated.
  
  
  RESULTS
  Higher neonatal procedural pain and infection, as well as other clinical factors, were differentially associated with reduced cerebellar volumes in specific subregions. After adjusting for clinical risk factors, neonatal procedural pain was distinctively associated with smaller volumes bilaterally in the posterior VIIIA and VIIIB lobules. Specific smaller cerebellar subregional volumes were related to poorer cognition and motor/visual integration.
  
  
  CONCLUSIONS
  In very preterm children, exposure to painful procedures, as well as additional neonatal risk factors such as infection, were associated with reduced cerebellar volumes in specific subregions and poorer outcomes at school age.
authors.affiliation: Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, British Columbia, Canada.
authors.forename: Manon
authors.initials: M
authors.lastname: Ranger
authors.affiliation: Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, British Columbia, Canada; Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Jill G
authors.initials: JG
authors.lastname: Zwicker
authors.affiliation: Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, British Columbia, Canada.
authors.forename: Cecil M Y
authors.initials: CM
authors.lastname: Chau
authors.affiliation: Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada.
authors.forename: Min Tae M
authors.initials: MT
authors.lastname: Park
authors.affiliation: Douglas Mental Health University Institute, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
authors.forename: M Mallar
authors.initials: MM
authors.lastname: Chakravarthy
authors.affiliation: Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, British Columbia, Canada.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Poskitt
authors.affiliation: Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Miller
authors.affiliation: Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, British Columbia, Canada.
authors.forename: Bruce H
authors.initials: BH
authors.lastname: Bjornson
authors.affiliation: Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada.
authors.forename: Emily W Y
authors.initials: EW
authors.lastname: Tam
authors.affiliation: Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada.
authors.forename: Vann
authors.initials: V
authors.lastname: Chau
authors.affiliation: Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, British Columbia, Canada.
authors.forename: Anne R
authors.initials: AR
authors.lastname: Synnes
authors.affiliation: Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, British Columbia, Canada. Electronic address: rgrunau@cw.bc.ca.
authors.forename: Ruth E
authors.initials: RE
authors.lastname: Grunau
mesh_terms: D002531:Cerebellum / Q000473:pathology*; D002648:Child; D002657:Child Development; D003071:Cognition; D005260:Female; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007234:Infant, Premature; D007239:Infections / Q000503:physiopathology*; D007363:Intensive Care Units, Neonatal; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D010146:Pain / Q000503:physiopathology*; D012307:Risk Factors