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The neural exposome influences the preterm fetal-to-neonatal connectome

Pediatric Research volume 95, pages 9–11 (2024)Cite this article

Plomgaard et al. present preliminary results using “a priori defined analysis” suggesting an association between an automated computational measure of electroencephalogram (EEG) (EEG burst sharpness, EB) and neurodevelopmental outcome at 2 years corrected age for a cohort of extremely preterm (EP) survivors. The authors reviewed results from previously published EEG literature suggesting that this specific quantitative measure could contribute to greater prognostic accuracy. A multicenter EP cohort was selected to study the diagnostic value of cerebral oximetry monitoring during the first postnatal days. A defined measure of BS was calculated using a single recording electrode over a two-hour period at 64 h of life (+/−8 h) for an initial trial cohort of 166 preterm children with a gestational age range of 26 weeks +5 days (+/– 10 days) who tolerated the procedure. Their predefined statistical analysis adjusted for gestational age (GA), sex, and brain injury compared with cranial ultrasound studies at 1 and 4 days of life. Neurodevelopmental (NDI) and mental development (MDI) indices for 58/97 were reported for those who passed quality control and survived through discharge. A receiver-operating curve using EB predicted a likelihood ratio of 2 (0.77) pertaining to NDI without statistical significance achieved for MDI. While acknowledging that prematurity represents a continuum of risk, only genetic factors were cited. No discussion of the continuum of reproductive, maternal-placental-fetal (MPF) triad, and neonatal gene–environment (G x E) interactions across developmental time was included that influence prematurity. No comparisons with serial neonatal neurointensive care assessments using multi-modal diagnostic parameters such as brain MRI or placental pathology were discussed in relation to their chosen comparison between EEG and cranial ultrasound.

Accepting the statistical challenges of small sample sizes with comparatively short-term follow-up assessments, the following commentary proposes consideration of the concept of the neural exposome1 when designing short- and long-term study protocols to assess specific diagnostic measures over the lifespan. Serial use of structural and functional biomarkers offers the most accurate clinical decisions in fetal-neonatal neurology (FNN) to anticipate adaptive or maladaptive neuroplasticity across the developmental-aging continuum.2 Interrelated G × E interactions influence reproductive, pregnancy, and neonatal health status associated with conditions of prematurity with a substantial subset of survivors who experience neurologic and mental health sequelae over their lifespans.

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Fig. 1: The neural exposome encompasses non-genetic and epigenetic factors that influence neurological disorders, diseases, and damage to the brain and nervous system.1

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  1. UH Rainbow Babies and Children’s Hospital Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA

    Mark S. Scher

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Scher, M.S. The neural exposome influences the preterm fetal-to-neonatal connectome. Pediatr Res 95, 9–11 (2024). https://doi.org/10.1038/s41390-023-02804-x

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