Long-term effects of preterm birth on cortical folding trajectories in early childhood

Abstract

Cortical folding emerges in the late prenatal period and undergoes rapid reorganization during early childhood. However, the long-term impact of folding alterations associated with preterm birth remains unclear. Herein, we analysed the structural MRI data of 56 preterm children and 206 full-term peers aged 1–7 years. We derived cortical metrics from the reconstructed cortical surfaces using a vertex-wise computation framework to characterize regional folding patterns. We then conducted a combined analysis of the local gyrification index and sulcal depth to explain folding patterns in the preterm brain. Compared with their full-term peers, preterm children exhibited a region-specific impairment pattern characterized by a significantly reduced local gyrification index and sulcal depth in the bilateral superior temporal gyrus and left superior frontal gyrus (P < 0.05). Notably, the sulcal depth in the superior temporal cortex showed significant differences between preterm and full-term children in its association with neurodevelopmental outcomes (P < 0.05), indicating an atypical structure–function relationship in preterm children. The local gyrification index was significantly reduced in the right isthmus cingulate and posterior cingulate gyri (P < 0.05), reflecting a simplified gyral configuration. The study findings suggest several folding patterns that capture diverse mechanisms of morphogenetic disruption, indicating that preterm birth induces persistent region-specific impairments in cortical folding that may affect neurodevelopmental domains. These folding-sensitive markers provide critical insights into the development of targeted interventions to optimize long-term neurodevelopmental outcomes.