Neurodevelopmental Trajectories in Preterm Neonates: Integrating Neuroimaging Modalities with Clinical Neurological Outcomes

Objectives: This narrative review aims to demonstrate how integrating neuroimaging with functional assessments and standardized protocols enhances the identification of long-term motor and psychiatric risks. Methods: This review synthesized 13 high-impact studies, from the last 5 years. The analysis focused on preterm infants (<37 weeks gestational age) and evaluated the correlation between neuroimaging (head ultrasound (HUS), Magnetic Resonance Imaging (MRI)), head circumference (HC), and functional assessments like Prechtl General Movements (GMs). Results: While HUS remains the primary bedside tool, its sensitivity for subtle, non-cystic white matter injury is limited compared to MRI. Both modalities demonstrate high negative predictive values at term-equivalent age (TEA) for excluding severe motor deficits. Structural markers, including increased ventricular midbody size, immature gyration, and bilateral lesion laterality, were strongly associated with Cerebral Palsy (CP) and gross motor delays. Furthermore, TEA assessments provided superior prognostic accuracy compared to early neonatal scans. Optimal outcomes were linked to the integration of neuroimaging with functional assessments (GMs) and reliable parental support to ensure follow-up compliance. Conclusions: A tiered HUS/MRI protocol combined with routine GMs assessment enables precise prognostic counseling. Correlating TEA imaging with long-term findings necessitates follow-up beyond 24 months.