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The following is a summary of “Preterm Sex Differences in Neurodevelopment and Brain Development From Early Life to 8 Years,” published in the August 2024 issue of Pediatrics by Christensen et al.

This study investigated sex differences in neurodevelopmental outcomes and brain development from early life through age 8 in preterm infants. Researchers conducted a prospective cohort study involving infants born very preterm (24-32 weeks gestation), tracking their development from birth to 8 years using standardized neurodevelopmental assessments. Brain magnetic resonance imaging (MRI) was performed at birth, term-equivalent age, and at 8 years to evaluate changes in brain structure. Multivariable generalized estimating equations were employed to explore the relationships between sex, severe brain injury, early pain exposure, fractional anisotropy (FA), and neurodevelopmental outcomes. 

The study included 78 males and 66 females with similar clinical risk factors. Results indicated that males had significantly lower cognitive scores (β=-3.8, P=0.02) and exhibited greater motor impairment (OR=1.8, P=0.04) than females across the study period. Additionally, males demonstrated reduced fractional anisotropy in superior white matter across all time points (β=-0.01, P=0.04). Sex also moderated the effects of severe brain injury and early pain exposure on neurodevelopmental outcomes. Specifically, males with severe brain injury had significantly lower cognitive scores at 3 years (P<0.001). In contrast, increased early pain exposure was associated with lower cognitive scores at 8 years in females (P=0.008), whereas males experienced greater motor impairment at 4.5 years (P=0.001) and 8 years (P=0.05). 

These findings suggest that males born preterm face more significant cognitive and motor development challenges than females, which are linked to differences in white matter maturation. Furthermore, the differential impact of severe brain injury and early pain exposure on neurodevelopmental outcomes based on sex highlights the varying responses to early-life adversities in preterm infants.

Source: sciencedirect.com/science/article/abs/pii/S0022347624003743