# Structural brain network in relation to language in school-aged extremely preterm children: A diffusion tensor imaging study

## TL;DR

This study identifies a brain network related to language in children born extremely preterm, revealing compensatory pathways and the influence of socioeconomic status.

## Contribution

The study identifies a novel structural brain network for language in preterm children, including regions beyond traditional language pathways.

## Key findings

- Language outcomes in preterm children are linked to a subnetwork of 16 brain regions in the left hemisphere.
- Extremely preterm children use compensatory neural pathways involving areas like the pars orbitalis and putamen.
- Language difficulties are not necessarily tied to neonatal brain injury but are related to socioeconomic status.

## Abstract

•A structural brain network was identified that relates to complex language in preterm born children at school age.•This language network contains areas from the known dorsal and ventral language pathways but also other, novel brain regions.•Language outcomes in preterm children were related to SES, but not to neonatal brain injury.•Extremely preterm born children might use compensatory neural pathways for language to make up for neuronal dysmaturation.

A structural brain network was identified that relates to complex language in preterm born children at school age.

This language network contains areas from the known dorsal and ventral language pathways but also other, novel brain regions.

Language outcomes in preterm children were related to SES, but not to neonatal brain injury.

Extremely preterm born children might use compensatory neural pathways for language to make up for neuronal dysmaturation.

Between 22 and 45 % of children born preterm experience difficulties with expressive and receptive language when they reach school age. Little is currently known about the neural mechanisms behind their linguistic performance. This study investigates the brain areas and white matter connections that form the structural language network in extremely preterm-born children who have reached school age. Structural brain connectivity was quantified using diffusion-weighted imaging (DWI) and tractography in n = 58 (62 % female) extremely preterm-born children aged 8–12 years. Language outcomes were assessed using the CELF-4-NL Recalling Sentences subtest. Language scores were below average in n = 13 (22 %) children. Language outcomes related significantly to a subnetwork of 16 brain regions (p = 0.012). The network comprised brain regions from the left hemisphere including the pars orbitalis, middle and superior frontal gyrus, frontal pole, pre- and postcentral gyrus, superior temporal gyrus, insula, caudate nucleus, thalamus, and putamen. In the right hemisphere, the anterior cingulate was part of the network. These findings suggest that extremely preterm children rely mostly on their left hemisphere during language processing, which is similar to typically developing children. However, they seem to use compensatory neural pathways that include brain areas right next to the areas typically involved in language processing. These areas include the pars orbitalis (adjacent to Broca’s area) and the putamen and caudate nucleus (adjacent to the limbic system). It is important to note that language difficulties were not necessarily related to brain injury around birth.