Predicting the Outcome of ADHD in White Matter Injure Neonates With Multi-modality MRI

First Affiliated Hospital Xi'an Jiaotong University348 enrolled

Overview

The goal of this bidirectional observational cohort study is to investigate the longitudinal relationship between neonatal white matter injury (WMI) and the subsequent development of attention-deficit/hyperactivity disorder (ADHD), and to identify early MRI-based markers associated with ADHD-related outcomes. The study includes both retrospective and prospective cohorts to dynamically evaluate the evolution of brain injury, brain development, and behavioral outcomes from infancy to childhood. The main questions it aims to answer are: Are neonatal WMI characteristics associated with the subsequent development of ADHD? Which MRI-derived features, including semi-quantitative WMI assessment, microstructural alterations, and structural disconnection patterns, are associated with ADHD-related outcomes? Participants with neonatal WMI will undergo longitudinal clinical, neurodevelopmental, and behavioral follow-up. Researchers will analyze clinical information and MRI findings to characterize WMI evolution and identify imaging markers associated with ADHD risk. Participants will: undergo brain MRI examinations according to clinical protocols; receive standardized neurodevelopmental and behavioral assessments during follow-up; have MRI-derived measures, including semi-quantitative WMI scores, white matter microstructural features, and structural disconnection measures, analyzed to investigate their associations with ADHD-related outcomes.

White matter injury (WMI) is a common form of neonatal brain injury and may be associated with altered brain development and later neurodevelopmental disorders. Previous studies have suggested that abnormalities in brain microstructure and connectivity after neonatal WMI may overlap with neural circuits involved in attention and executive function. However, the longitudinal evolution of neonatal WMI and its relationship with the development of attention-deficit/hyperactivity disorder (ADHD) remain incompletely understood. This bidirectional observational cohort study will investigate the association between neonatal WMI characteristics and later ADHD-related outcomes through longitudinal clinical and neuroimaging follow-up. The study includes retrospective and prospective cohorts to characterize brain developmental trajectories after neonatal WMI. Multimodal MRI analyses were performed to quantify WMI-related brain alterations, including conventional MRI-based semi-quantitative assessment, white matter microstructural measurements, and structural disconnection analysis. These MRI-derived features were evaluated in relation to subsequent neurodevelopmental and behavioral outcomes to identify early imaging markers associated with ADHD risk.

Study Type

Eligibility

Sex: ALLMin age: 1 Day

Medical Language ↔ Plain English

Inclusion Criteria: * Neonates diagnosed with white matter injury (WMI) or neonates without obvious abnormalities on routine MRI examination from the multicenter database. * Brain MRI examination performed within 28 days after birth, with gestational age ≤42 weeks at examination. * Complete MRI data available, including T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), and diffusion tensor imaging (DTI). * Complete maternal and pregnancy history information, neonatal demographic characteristics, and clinical information available. Exclusion Criteria: * Congenital nervous system developmental malformations or suspected genetic or metabolic diseases. * Obvious MRI artifacts affecting image evaluation. * Inability to complete follow-up neurobehavioral assessments.

Locations (9)

First Affiliated Hospital of Xi'an Jiaotong University

Xi'an, Shaanxi, China

Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University

Hangzhou, China

Gansu Province Maternity and Child Health Hospital

Lanzhou, China

Qinghai Red Cross Hospital

Qinghai, China

Hebei Children's Hospital

Shijiazhuang, China

Children's Hospital of Soochow University

Suzhou, China

Wuxi Children's Hospital

Wuxi, China

Northwest Women's and Children's Hospital

Xi'an, China

The Second Affiliated Hospital of Shaanxi University of Chinese Medicine

Xianyang, China

Outcomes

Primary Outcomes

Attention-Deficit/Hyperactivity Disorder (ADHD) Diagnosis

ADHD diagnosis will be determined according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria, combined with standardized behavioral assessment using the Swanson, Nolan, and Pelham (SNAP) questionnaire. The number of participants meeting the diagnostic criteria for ADHD at follow-up will be recorded.

Time frame: At 3-5 years of age

Secondary Outcomes

Cognitive Developmental Outcome

Cognitive development will be assessed using standardized developmental assessment tools, including the Bayley Scales of Infant Development, Second Edition (BSID-II), Gesell Developmental Schedules, and the Developmental scale for children aged 0\~6 years, according to participant age and assessment availability. Cognitive developmental scores will be recorded, and cognitive impairment will be defined according to predefined criteria. The associations between early MRI findings, including semi-quantitative WMI assessment, white matter microstructural features, and structural disconnection measures, and cognitive developmental outcomes will be evaluated.

Time frame: During infancy follow-up assessments (6 months to 5 years of age)

Motor Developmental Outcome

Motor development will be assessed using standardized developmental assessment tools, including the Bayley Scales of Infant Development, Second Edition (BSID-II), Gesell Developmental Schedules, and the Developmental scale for children aged 0\~6 years, according to participant age and assessment availability. Motor developmental scores will be recorded, and motor impairment will be defined according to predefined criteria. The associations between early MRI findings, including semi-quantitative WMI assessment, white matter microstructural features, and structural disconnection measures, and motor developmental outcomes will be evaluated.