Skip to main content
Top
Published in: Child's Nervous System 8/2017

01-08-2017 | Original Paper

Regional brain volume reduction and cognitive outcomes in preterm children at low risk at 9 years of age

Authors: Ebru Arhan, Kıvılcım Gücüyener, Şebnem Soysal, Şafak Şalvarlı, M. Ali Gürses, Ayşe Serdaroğlu, Ercan Demir, Ebru Ergenekon, Canan Türkyılmaz, Esra Önal, Esin Koç, Yıldız Atalay

Published in: Child's Nervous System | Issue 8/2017

Login to get access

Abstract

Objective

More information is needed on “low-risk” preterm infants’ neurological outcome so that they can be included in follow-up programs. A prospective study was performed to examine the regional brain volume changes compared to term children and to assess the relationship between the regional brain volumes to cognitive outcome of the low-risk preterm children at 9 years of age.

Patients

Subjects comprised 22 preterm children who were determined to be at low risk for neurodevelopmental deficits with a gestational age between 28 and 33 weeks without a major neonatal morbidity in the neonatal period and 24 age-matched term control children term and matched for age, sex, and parental educational and occupational status.

Methods

Regional volumetric analysis was performed for cerebellum, hippocampus, and corpus callosum area. Cognitive outcomes of both preterm and control subjects were assessed by Weschler Intelligence Scale for Children Revised (Turkish version), and attention and executive functions were assessed by Wisconsin Card Sorting Test and Stroop Test TBAG version.

Results

Low-risk preterm children showed regional brain volume reduction in cerebellum, hippocampus, and corpus callosum area and achieved statistical significance when compared with term control. When the groups were compared for all WISC-R subscale scores, preterm children at low risk had significantly lower scores on information, vocabulary, similarities, arithmetics, picture completion, block design, object assembly, and coding compared to children born at term. Preterm and term groups were compared on the Stroop Test for mistakes and corrections made on each card, the time spent for completing each card, and total mistakes and corrections. In the preterm group, we found a positive correlation between regional volumes with IQ, attention, and executive function scores. Additionally, a significant correlation was found between cerebellar volume and attention and executive function scores in the preterm group.

Conclusion

Low-risk preterm children achieve lower scores in neurophysiological tests than children born at term. Preterm birth itself has a significant impact on regional brain volumes and cognitive outcome of children at 9 years of age. It is a risk factor for regional brain volume reductions in preterm children with low risk for neurodevelopmental deficits. The significant interaction between cerebellar volume reduction and executive function and attention may suggest that even in preterm children at low risk can have different trajectories in the growth and development of overall brain structure.
Literature
1.
go back to reference Panigrahy A, Barnes PD, Robertson RL, Back SA, Sleeper LA, Sayre JW, Kinney HC, Volpe JJ (2001) Volumetric brain differences in children with periventricular T2-signal hyperintensities: a grouping by gestational age at birth. AJR Am J Roentgenol 177:695–702CrossRefPubMed Panigrahy A, Barnes PD, Robertson RL, Back SA, Sleeper LA, Sayre JW, Kinney HC, Volpe JJ (2001) Volumetric brain differences in children with periventricular T2-signal hyperintensities: a grouping by gestational age at birth. AJR Am J Roentgenol 177:695–702CrossRefPubMed
2.
go back to reference Cooke RW, Abernethy LJ (1999) Cranial magnetic resonance imaging and school performance in very low birth weight infants in adolescence. Arch Dis Child Fetal Neonatal Ed 81:F116F121CrossRef Cooke RW, Abernethy LJ (1999) Cranial magnetic resonance imaging and school performance in very low birth weight infants in adolescence. Arch Dis Child Fetal Neonatal Ed 81:F116F121CrossRef
3.
go back to reference Tyson JE, Parikh NA, Langer J, Green C, Higgins RD et al (2008) Intensive care for extreme prematurity–moving beyond gestational age. N Engl J Med 358:1672–1681CrossRefPubMedPubMedCentral Tyson JE, Parikh NA, Langer J, Green C, Higgins RD et al (2008) Intensive care for extreme prematurity–moving beyond gestational age. N Engl J Med 358:1672–1681CrossRefPubMedPubMedCentral
4.
go back to reference Inder TE, Warfield SK, Wang H, Huppi PS, Volpe JJ (2005) Abnormal cerebral structure is present at term in premature infants. Pediatrics 115:286–294CrossRefPubMed Inder TE, Warfield SK, Wang H, Huppi PS, Volpe JJ (2005) Abnormal cerebral structure is present at term in premature infants. Pediatrics 115:286–294CrossRefPubMed
5.
go back to reference Peterson BS, Anderson AW, Ehrenkranz R, Staib LH, Tageldin M et al (2003) Regional brain volumes and their later neurodevelopmental correlates in term and preterm infants. Pediatrics 111:939–948CrossRefPubMed Peterson BS, Anderson AW, Ehrenkranz R, Staib LH, Tageldin M et al (2003) Regional brain volumes and their later neurodevelopmental correlates in term and preterm infants. Pediatrics 111:939–948CrossRefPubMed
6.
go back to reference Thompson DK, Warfield SK, Carlin JB, Pavlovic M, Wang HX et al (2007) Perinatal risk factors altering regional brain structure in the preterm infant. Brain 130:667–677CrossRefPubMed Thompson DK, Warfield SK, Carlin JB, Pavlovic M, Wang HX et al (2007) Perinatal risk factors altering regional brain structure in the preterm infant. Brain 130:667–677CrossRefPubMed
7.
go back to reference Kesler SR, Ment LR, Vohr B, Pajot SK, Schneider KC, Katz KH, Ebbitt TB, Duncan CC, Makuch RW, Riess AL (2004) Volumetric analysis of regional cerebral development in preterm children. Pediatr Neurol 31:318–325CrossRefPubMedPubMedCentral Kesler SR, Ment LR, Vohr B, Pajot SK, Schneider KC, Katz KH, Ebbitt TB, Duncan CC, Makuch RW, Riess AL (2004) Volumetric analysis of regional cerebral development in preterm children. Pediatr Neurol 31:318–325CrossRefPubMedPubMedCentral
8.
go back to reference Lind A, Haataja L, Rautava L, Valiaho A, Lehtonen L et al (2010) Relations between brain volumes, neuropsychological assessment and parental questionnaire in prematurely born children. Eur Child Adolesc Psychiatry 19:407–417CrossRefPubMed Lind A, Haataja L, Rautava L, Valiaho A, Lehtonen L et al (2010) Relations between brain volumes, neuropsychological assessment and parental questionnaire in prematurely born children. Eur Child Adolesc Psychiatry 19:407–417CrossRefPubMed
9.
go back to reference Badr LK, Bookheimer S, Purdy I, Deeb M (2009) Predictors of neurodevelopmental outcome for preterm infants with brain injury: MRI, medical and environmental factors. Early Hum Dev 85:279–284CrossRefPubMedPubMedCentral Badr LK, Bookheimer S, Purdy I, Deeb M (2009) Predictors of neurodevelopmental outcome for preterm infants with brain injury: MRI, medical and environmental factors. Early Hum Dev 85:279–284CrossRefPubMedPubMedCentral
10.
go back to reference Dyet LE, Kennea N, Counsell SJ, Maalouf EF, Ajayi-Obe M et al (2006) Natural history of brain lesions in extremely preterm infants studied with serial magnetic resonance imaging from birth and neurodevelopmental assessment. Pediatrics 118:536–548CrossRefPubMed Dyet LE, Kennea N, Counsell SJ, Maalouf EF, Ajayi-Obe M et al (2006) Natural history of brain lesions in extremely preterm infants studied with serial magnetic resonance imaging from birth and neurodevelopmental assessment. Pediatrics 118:536–548CrossRefPubMed
11.
go back to reference Iwata S, Nakamura T, Hizume E, Kihara H, Takashima S et al (2012) Qualitative brain MRI at term and cognitive outcomes at 9 years after very preterm birth. Pediatrics 129:1138–1147CrossRef Iwata S, Nakamura T, Hizume E, Kihara H, Takashima S et al (2012) Qualitative brain MRI at term and cognitive outcomes at 9 years after very preterm birth. Pediatrics 129:1138–1147CrossRef
12.
go back to reference Hart AR, Whitby EW, Griffiths PD, Smith MF (2008) Magnetic resonance imaging and developmental outcome following preterm birth: review of current evidence. Dev Med Child Neurol 50:655–663CrossRefPubMed Hart AR, Whitby EW, Griffiths PD, Smith MF (2008) Magnetic resonance imaging and developmental outcome following preterm birth: review of current evidence. Dev Med Child Neurol 50:655–663CrossRefPubMed
13.
go back to reference Caravale B, Tozzi C, Albino G, Vicari S (2005) Cognitive development in low risk preterm infants at 3– 4 years of life. Arch Dis Child Fetal Neonatal Ed 90:474–479CrossRef Caravale B, Tozzi C, Albino G, Vicari S (2005) Cognitive development in low risk preterm infants at 3– 4 years of life. Arch Dis Child Fetal Neonatal Ed 90:474–479CrossRef
14.
go back to reference Ment LR, Hirtz D, Huppi PS (2009) Imaging biomarkers of outcome in the developing preterm brain. Lancet Neurol 8:1042–1055CrossRefPubMed Ment LR, Hirtz D, Huppi PS (2009) Imaging biomarkers of outcome in the developing preterm brain. Lancet Neurol 8:1042–1055CrossRefPubMed
15.
go back to reference Bonifacio SL, Glass HC, Chau V, Berman JI, Xu D, Brant R et al (2010) Extreme premature birth is not associated with impaired development of brain microstructure. J Pediatr 157:726–32.e1CrossRefPubMedPubMedCentral Bonifacio SL, Glass HC, Chau V, Berman JI, Xu D, Brant R et al (2010) Extreme premature birth is not associated with impaired development of brain microstructure. J Pediatr 157:726–32.e1CrossRefPubMedPubMedCentral
16.
go back to reference Peterson BS, Vohr B, Staib LH, Cannistraci CJ, Dolberg A et al (2000) Regional brain volume abnormalities and long-term cognitive outcome in preterm infants. JAMA 284:1939–1947CrossRefPubMed Peterson BS, Vohr B, Staib LH, Cannistraci CJ, Dolberg A et al (2000) Regional brain volume abnormalities and long-term cognitive outcome in preterm infants. JAMA 284:1939–1947CrossRefPubMed
17.
go back to reference Nosarti C, Giouroukou E, Healy E, Rifkin L, Walshe M et al (2008) Grey and white matter distribution in very preterm adolescents mediates neurodevelopmental outcome. Brain 131:205–217CrossRefPubMed Nosarti C, Giouroukou E, Healy E, Rifkin L, Walshe M et al (2008) Grey and white matter distribution in very preterm adolescents mediates neurodevelopmental outcome. Brain 131:205–217CrossRefPubMed
18.
go back to reference Soria-Pastor S, Padilla N, Zubiaurre-Elorza L, Ibarretxe-Bilbao N, Botet F, Costas-Moragas C, Falcon C, Bargallo N, Mercader JM, Junqué C (2009) Decreased regional brain volume and cognitive impairment in preterm children at low risk. Pediatrics 124:1161–1170CrossRef Soria-Pastor S, Padilla N, Zubiaurre-Elorza L, Ibarretxe-Bilbao N, Botet F, Costas-Moragas C, Falcon C, Bargallo N, Mercader JM, Junqué C (2009) Decreased regional brain volume and cognitive impairment in preterm children at low risk. Pediatrics 124:1161–1170CrossRef
19.
go back to reference Woodward LJ, Anderson PJ, Austin NC, Howard K, Inder TE (2006) Neonatal MRI to predict neurodevelopmental outcomes in preterm infants. N Engl J Med 355:685–694CrossRefPubMed Woodward LJ, Anderson PJ, Austin NC, Howard K, Inder TE (2006) Neonatal MRI to predict neurodevelopmental outcomes in preterm infants. N Engl J Med 355:685–694CrossRefPubMed
20.
go back to reference Savaşır, I. & Şahin, N. (1982). Wechsler Çocuklar İçin Zeka Ölçeği (WISC-R) El Kitabı. Ankara. Türk Psikologlar Derneği Yayınları. Savaşır, I. & Şahin, N. (1982). Wechsler Çocuklar İçin Zeka Ölçeği (WISC-R) El Kitabı. Ankara. Türk Psikologlar Derneği Yayınları.
21.
go back to reference Bekçi B, Karakaş S (2009) Perceptual conflict and response competition: event-related potentials of the stroop effect. Turk Psikiyatri Derg 20:127–137PubMed Bekçi B, Karakaş S (2009) Perceptual conflict and response competition: event-related potentials of the stroop effect. Turk Psikiyatri Derg 20:127–137PubMed
22.
go back to reference Lemieux L, Wieshmann UC, Moran NF, Fish DR, Shorvon SD (1998) The detection and significance of subtle changes in mixed-signal brain lesions by serial MRI scan matching and spatial normalization. Med Image Anal 2:227–242CrossRefPubMed Lemieux L, Wieshmann UC, Moran NF, Fish DR, Shorvon SD (1998) The detection and significance of subtle changes in mixed-signal brain lesions by serial MRI scan matching and spatial normalization. Med Image Anal 2:227–242CrossRefPubMed
23.
go back to reference Watson C, Andermann F, Gloor P, Jones-Gotman M, Peters T, Evans A et al (1992) Anatomic basis of amygdaloid and hippocampal volume measurement by magnetic resonance imaging. Neurology 42:1743–1750CrossRefPubMed Watson C, Andermann F, Gloor P, Jones-Gotman M, Peters T, Evans A et al (1992) Anatomic basis of amygdaloid and hippocampal volume measurement by magnetic resonance imaging. Neurology 42:1743–1750CrossRefPubMed
24.
go back to reference Lemieux L, Liu RS, Duncan JS (2000) Hippocampal and cerebellar volumetry in serially acquired MRI volume scans. Magn Reson Imaging 18:1027–1033CrossRefPubMed Lemieux L, Liu RS, Duncan JS (2000) Hippocampal and cerebellar volumetry in serially acquired MRI volume scans. Magn Reson Imaging 18:1027–1033CrossRefPubMed
25.
go back to reference Martinussen M, Flanders DW, Fischl B, Busa E, Løhaugen GC, Skranes J, Vangberg TR, Brubakk AM, Haraldseth O, Dale AM (2009) Segmental brain volumes and cognitive and perceptual correlates in 15-year-old adolescents with low birth weight. J Pediatr 155:848–853CrossRefPubMed Martinussen M, Flanders DW, Fischl B, Busa E, Løhaugen GC, Skranes J, Vangberg TR, Brubakk AM, Haraldseth O, Dale AM (2009) Segmental brain volumes and cognitive and perceptual correlates in 15-year-old adolescents with low birth weight. J Pediatr 155:848–853CrossRefPubMed
26.
go back to reference Streiner DL, Norman GR (1995) Health measurement scales. A practical guide to their development and use. Oxford Medical, London Streiner DL, Norman GR (1995) Health measurement scales. A practical guide to their development and use. Oxford Medical, London
27.
go back to reference Cronbach LJ (1951) Coefficient alpha and the internal structure of the tests. Psychometrika 16 Cronbach LJ (1951) Coefficient alpha and the internal structure of the tests. Psychometrika 16
28.
go back to reference Pepe MS (2003) The Statistical Evaluation of Medical Tests for Classification and Prediction. Oxford University Press, Inc, New York Pepe MS (2003) The Statistical Evaluation of Medical Tests for Classification and Prediction. Oxford University Press, Inc, New York
29.
31.
go back to reference Lenroot RK, Giedd JN (2006) Brain development in children and adolescents: insights from anatomical magnetic resonance imaging. Neurosci Biobehav Rev 30:718–729CrossRefPubMed Lenroot RK, Giedd JN (2006) Brain development in children and adolescents: insights from anatomical magnetic resonance imaging. Neurosci Biobehav Rev 30:718–729CrossRefPubMed
32.
go back to reference Isaacs EB, Lucas A, Chong WK et al (2000) Hippocampal volume and everyday memory in children of very low birth weight. Pediatr Res 47:713–720CrossRefPubMed Isaacs EB, Lucas A, Chong WK et al (2000) Hippocampal volume and everyday memory in children of very low birth weight. Pediatr Res 47:713–720CrossRefPubMed
33.
go back to reference Reiss AL, Kesler SR, Vohr B et al (2004) Sex differences in cerebral volumes of 8-year-old born preterm. J Pediatr 145:242–249CrossRefPubMed Reiss AL, Kesler SR, Vohr B et al (2004) Sex differences in cerebral volumes of 8-year-old born preterm. J Pediatr 145:242–249CrossRefPubMed
34.
go back to reference Stewart AL, Rifkin L, Amess PN et al (1999) Brain structure and neurocognitive and behavioral function in adolescents who were born very preterm. Lancet 353:1653–1657CrossRefPubMed Stewart AL, Rifkin L, Amess PN et al (1999) Brain structure and neurocognitive and behavioral function in adolescents who were born very preterm. Lancet 353:1653–1657CrossRefPubMed
35.
go back to reference Jeon TY, Kim JH, Yoo SY, Eo H, Kwon JY, Lee J, Lee M, Chang YS, Park WS (2012) Neurodevelopmental outcomes in preterm infants: comparison of infants with and without diffuse excessive high signal intensity on MR images at near-term-equivalent age. Radiology 263:518–526CrossRefPubMed Jeon TY, Kim JH, Yoo SY, Eo H, Kwon JY, Lee J, Lee M, Chang YS, Park WS (2012) Neurodevelopmental outcomes in preterm infants: comparison of infants with and without diffuse excessive high signal intensity on MR images at near-term-equivalent age. Radiology 263:518–526CrossRefPubMed
36.
go back to reference Thompson DK, Wood SJ, Doyle LW, Warfield SK, Lodygensky GA, Anderson PJ, Egan GF, Inder TE (2008) Neonate hippocampal volumes: prematurity, perinatal predictors, and 2-year outcome. Ann Neurol 63:642–651CrossRefPubMed Thompson DK, Wood SJ, Doyle LW, Warfield SK, Lodygensky GA, Anderson PJ, Egan GF, Inder TE (2008) Neonate hippocampal volumes: prematurity, perinatal predictors, and 2-year outcome. Ann Neurol 63:642–651CrossRefPubMed
37.
go back to reference Nosarti C, Rushe TM, Woodruff PWR, Stewart AL, Rifkin L, Murray RM (2004) Corpus Callosum size and very preterm birth: relationship to neuropsychological outcome. Brain 127:2080–2089CrossRefPubMed Nosarti C, Rushe TM, Woodruff PWR, Stewart AL, Rifkin L, Murray RM (2004) Corpus Callosum size and very preterm birth: relationship to neuropsychological outcome. Brain 127:2080–2089CrossRefPubMed
38.
go back to reference Nagy Z, Westerberg H, Skare S, Andersson JL, Lilja A, Flodmark O et al (2003) Preterm children have disturbances of white matter at 11 years of age as shown by diffusion tensor imaging. Pediatr Res 54:672–679CrossRefPubMed Nagy Z, Westerberg H, Skare S, Andersson JL, Lilja A, Flodmark O et al (2003) Preterm children have disturbances of white matter at 11 years of age as shown by diffusion tensor imaging. Pediatr Res 54:672–679CrossRefPubMed
40.
go back to reference Langmeier M, Pokorny J, Mares J, Trojan S (1989) Changes of the neuronal structure produced by prolonged hypobaric hypoxia in infant rats. Biomed Biochim Acta 48:S204–S207PubMed Langmeier M, Pokorny J, Mares J, Trojan S (1989) Changes of the neuronal structure produced by prolonged hypobaric hypoxia in infant rats. Biomed Biochim Acta 48:S204–S207PubMed
41.
go back to reference Marlow N, Wolke D, Bracewell MA (2005) SamaraM, EPICure study group. Neurologic and developmental disability at six years of age after extremely preterm birth. N Engl J Med 352:9–19CrossRefPubMed Marlow N, Wolke D, Bracewell MA (2005) SamaraM, EPICure study group. Neurologic and developmental disability at six years of age after extremely preterm birth. N Engl J Med 352:9–19CrossRefPubMed
42.
go back to reference Aylward GP (2002) Cognitive and neuropsychological outcomes: more than IQ scores. Ment Retard Dev Disabil Res Rev 8:234–240CrossRefPubMed Aylward GP (2002) Cognitive and neuropsychological outcomes: more than IQ scores. Ment Retard Dev Disabil Res Rev 8:234–240CrossRefPubMed
43.
go back to reference Fedrizzi E, Zuccarino ML, Vizziello P (1986) Clinical problems in neurodevelopmental diagnosis: a 7-year neurological and psychological follow-up study of low risk preterm infants. Ital J Neurol Sci 5(suppl):117–126PubMed Fedrizzi E, Zuccarino ML, Vizziello P (1986) Clinical problems in neurodevelopmental diagnosis: a 7-year neurological and psychological follow-up study of low risk preterm infants. Ital J Neurol Sci 5(suppl):117–126PubMed
44.
go back to reference O’Brien F, Roth S, Stewart A, Rifkin L, Rushe T, Wyatt J (2004) The neurodevelopmental progress of infants less than 33 weeks into adolescence. Arch Dis Child 89:207–211CrossRefPubMedPubMedCentral O’Brien F, Roth S, Stewart A, Rifkin L, Rushe T, Wyatt J (2004) The neurodevelopmental progress of infants less than 33 weeks into adolescence. Arch Dis Child 89:207–211CrossRefPubMedPubMedCentral
45.
go back to reference Allin M, Matsumoto H, Santhouse AM et al (2001) Cognitive and motor function and the size of the cerebellum in adolescents born very pre-term. Brain 124:60–66CrossRefPubMed Allin M, Matsumoto H, Santhouse AM et al (2001) Cognitive and motor function and the size of the cerebellum in adolescents born very pre-term. Brain 124:60–66CrossRefPubMed
46.
go back to reference Soria-Pastor S, Gimenez M, Narberhaus A et al (2008) Patterns of cerebral white matter damage and cognitive impairment in adolescents born very preterm. Int J Dev Neurosci 26:647–654CrossRefPubMed Soria-Pastor S, Gimenez M, Narberhaus A et al (2008) Patterns of cerebral white matter damage and cognitive impairment in adolescents born very preterm. Int J Dev Neurosci 26:647–654CrossRefPubMed
47.
go back to reference Johnson S (2007) Cognitive and behavioural outcomes following very preterm birth. Semin Fetal Neonatal Med 12:363–373CrossRefPubMed Johnson S (2007) Cognitive and behavioural outcomes following very preterm birth. Semin Fetal Neonatal Med 12:363–373CrossRefPubMed
48.
go back to reference Mallard C, Loeliger M, Copolov D, Rees S (2000) Reduced number of neurons in the hippocampus and the cerebellum in the postnatal guinea-pig following intrauterine growth-restriction. Neuroscience 100:327–333CrossRefPubMed Mallard C, Loeliger M, Copolov D, Rees S (2000) Reduced number of neurons in the hippocampus and the cerebellum in the postnatal guinea-pig following intrauterine growth-restriction. Neuroscience 100:327–333CrossRefPubMed
49.
go back to reference Duara R, Kushch A, Gross-Glenn K, Barker WW, Jallad B, Pascal S et al (1991) Neuroanatomic differences between dyslexic and normal readers on magnetic resonance imaging scans. Arch Neurol 48:410–416CrossRefPubMed Duara R, Kushch A, Gross-Glenn K, Barker WW, Jallad B, Pascal S et al (1991) Neuroanatomic differences between dyslexic and normal readers on magnetic resonance imaging scans. Arch Neurol 48:410–416CrossRefPubMed
50.
go back to reference Rumsey JM, Casanova M, Mannheim GB, Patronas N, De Vaughn N, Hamburger SD et al (1996) Corpus Callosum morphology, as measured with MRI, in dyslexic men. Biol Psychiatry 39:769–775CrossRefPubMed Rumsey JM, Casanova M, Mannheim GB, Patronas N, De Vaughn N, Hamburger SD et al (1996) Corpus Callosum morphology, as measured with MRI, in dyslexic men. Biol Psychiatry 39:769–775CrossRefPubMed
51.
go back to reference Njiokiktjien C (1990) Developmental dysphasia: clinical importance and underlying neurological causes. Acta Paedopsychiatr 53:126–123PubMed Njiokiktjien C (1990) Developmental dysphasia: clinical importance and underlying neurological causes. Acta Paedopsychiatr 53:126–123PubMed
52.
go back to reference Fabbro F, Libera L, Tavano A (2002) A callosal transfer deficit in children with developmental language disorder. Neuropsychologia 40:1541–1546CrossRefPubMed Fabbro F, Libera L, Tavano A (2002) A callosal transfer deficit in children with developmental language disorder. Neuropsychologia 40:1541–1546CrossRefPubMed
Metadata
Title
Regional brain volume reduction and cognitive outcomes in preterm children at low risk at 9 years of age
Authors
Ebru Arhan
Kıvılcım Gücüyener
Şebnem Soysal
Şafak Şalvarlı
M. Ali Gürses
Ayşe Serdaroğlu
Ercan Demir
Ebru Ergenekon
Canan Türkyılmaz
Esra Önal
Esin Koç
Yıldız Atalay
Publication date
01-08-2017
Publisher
Springer Berlin Heidelberg
Published in
Child's Nervous System / Issue 8/2017
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-017-3421-2

Other articles of this Issue 8/2017

Child's Nervous System 8/2017 Go to the issue