Bronchopulmonary Dysplasia Is Associated with Later Working Memory Subtest Vulnerability and White Matter Microstructural Alterations in Preterm Infants

Objective: Bronchopulmonary dysplasia (BPD) is a common respiratory complication in preterm infants.Although BPD is a recognized predictor of adverse long-term neurodevelopment, few studies have investigated its association with alterations in white matter (WM) microstructure and neurodevelopmental outcomes.Expanding upon our previous findings of regional WM alterations in infants with BPD, this study aimed to investigate the associations between these microstructural changes and long-term neurodevelopmental outcomes at 18-24 months and 3-5 years.Methods: A total of 59 preterm infants (gestational age <32 weeks; birth weight <1,500 g) without focal structural brain abnormalities underwent magnetic resonance imaging and diffusion tensor imaging (DTI) at term-equivalent age.Neurodevelopment was assessed using the Korean Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) at 18-24 months of corrected age and the Korean Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition at 3-5 years of age.DTI were analyzed in the corpus callosum (CC), corticospinal tract, and middle cerebellar peduncle (MCP).Results: There were no significant group differences in BSID-III scores at 18-24 months.However, at 3-5 years, preterm infants with BPD showed lower performance on a visuospatial short-term memoryrelated subtest.In terms of WM microstructure, working memory performance was significantly associated with alterations in axial diffusivity within the CC and MCP.Conclusion: These findings suggest that regional WM microstructural alterations at term-equivalent age in infant born preterm with BPD are associated with cognitive vulnerabilities-particularly in verbal comprehension, visual spatial and visuospatial short-term memory-related index-at 3-5 years of age.