Structural and functional connectivity in infancy relate to communication skills at age 2 in children born very preterm

Preterm birth is associated with increased risk for communication difficulties, yet early neural markers of later outcomes remain poorly understood. This study examined associations between structural and functional brain connectivity in infancy and communication skills at 24to 30 months in children born very preterm ([≤]32 weeks gestation). Participants (n = 180) MRI at term-equivalent age during natural sleep. Resting-state functional and diffusion data were used to derive structural and functional connectivity across regions implicated in communication. At follow-up, communication outcomes were assessed using Communication and Symbolic Behavior Scales (CSBS), which captures verbal, gestural, social-affective, and symbolic communication skills. We analyzed 22x22 functional and structural connectomes among selected ROIs, using a LASSO regression approach to identify connectivity associated with CSBS scores adjusting for demographic and medical covariates. Significant relationships were observed between both functional and structural connectivity and communication skills, differing by domain. Functional connectivity between left and right temporal regions was positively associated with overall communication scores, whereas several structural connections involving cortical, cerebellar, and subcortical regions showed negative associations. Distinct connectivity patterns were also associated with gestural, verbal, social-affective, and symbolic communication skills. These findings demonstrate that variability in early brain connectivity is associated with later communication outcomes in children born very preterm. We found both significant positive and negative associations after adjusting for relevant covariates; these patterns potentially reflect compensatory or atypical network organization. These results highlight the value of multimodal neuroimaging in identifying early neural correlates of communication in this high-risk population.