Abstract
Very preterm birth is associated with later social-emotional impairments, which may result from enhanced vulnerability of the limbic system during this period of heightened susceptibility in early life. In a prospective cohort study, neonates born very preterm (< 30 weeks’ gestation) underwent MRI scanning at term-equivalent age (TEA) and clinical data were collected. Procedural pain was operationalized as the number of skin breaking procedures. Amygdala volumes were automatically extracted. The Strengths and Difficulties questionnaire was used to assess social-emotional outcomes at 5 years of age. General Linear Models were employed to examine the association between neonatal amygdala volumes and social-emotional outcomes, with the timing of procedural pain exposure employed as a moderator in subsequent models. 42 preterm infants were recruited. Larger right amygdala volumes at TEA were associated with impaired prosocial behaviour. Procedural pain was found to moderate the relationship between right amygdala volumes and conduct problems, such that early or late skin breaking procedures experienced within the first few weeks of life strengthened this association. Examination of sensitive windows when the developing brain may be most vulnerable to the adverse effects of procedural pain may inform pain management practices to improve social-emotional outcomes in this population.