Neurodevelopmental challenges following preterm birth: effects on brain structure and function with a focus on visual perception

Abstract

Preterm birth is prevalent globally, with approximately 15 million babies born preterm annually. The number of surviving preterm babies has been increasing in recent years due to advancements in medical interventions. This highlights the urgent need to understand the long-term effects of preterm birth, especially on brain development, to minimize the potential negative impacts and to develop effective rehabilitative strategies. Preterm birth disrupts brain development, leaves the infant exposed to environmental stimuli that they are not ready to process, and often leads to brain damage. Two crucial stages of structural and functional brain development are thought to be significantly disrupted due to preterm birth: myelination and synaptic pruning. As a result, preterm birth often coexists with neurodevelopmental disorders affecting motor and cognitive, perceptual systems. The impairments in visual abilities, especially in perceptual domain, are of particular interest, as these issues often go unnoticed and negatively impact academic performance. Notably, these effects can be observed even in the absence of significant brain damage and frequently persist into adulthood. Therefore, this review aims to emphasize the urgent need to address this critical public health concern by comprehensively characterizing the effects of preterm birth on visual functioning and investigating the underlying neural mechanisms. Two hypotheses have been proposed in the literature to explain the neural basis of visual deficits associated with preterm birth. The first posits that preterm birth mainly disrupts the functioning of the dorsal visual pathway, resulting in poorer performance on visuospatial tasks. The second hypothesis suggests that compensatory mechanisms may be involved, where non-visual brain areas compensate for impairments in visual information processing by eliciting higher activations than usual. In this review, inspired by findings from the recent literature on impaired visuospatial processing abilities in early brain-based visual impairments, we propose an alternative hypothesis that preterm birth may be associated with global visual impairment, likely resulting from impaired top-down information processing.

Keywords

• brain development
• dorsal stream dysfunction
• Preterm birth
• prematurity
• top-down processing
• visual impairment
• visual perception

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