MRI has become a critical tool for neonatology, as a way to characterise injury to brain structures. However, even when MRI is combined with other available tools, for many infants from the NICU it remains difficult to answer one of the most pressing questions, which is whether an infant will develop attentional, behavioural or cognitive impairments later in life. The standard-of-care, therefore, is often to “wait-and-see” what impairments emerge during development, but this precludes early intervention.
At present, a barrier to earlier diagnosis is that the infant brain exhibits considerable plasticity, and so that even when injury to brain structures is present, brain function can develop normally. We propose, therefore, that it is critical not just to measure brain structure, but to also measure brain function. A powerful tool with which to do this is functional MRI (fMRI), which has potential to provide powerful insight into atypical development.
Disruption to early development by extremely preterm birth or hypoxia creates a considerable risk of intellectual disability. These perinatal neurological conditions account for a substantial proportion of the total burden of human disease4, emphasising the societal need for new diagnostic tools and intervention strategies to reduce lifelong intellectual disability. After being overlooked in classic works, there is growing evidence that developmental processes during childhood are critical in shaping complex cognition6. Development is more protracted in more intelligent species and the genes that are primarily associated with individual differences in intelligence are those that control the brain development.