Vascular-Metabolic Coupling in the Preterm Brain: A Framework Linking Cerebral Perfusion and Metabolic Dysmaturation

Abstract

Preterm birth interrupts essential stages of brain blood vessels and metabolism development. It links to a high chance of long-term neurodevelopmental issues. Problems in brain blood flow and metabolism in preterm infants are known, yet they are usually studied separately. So, the link between blood vessel instability and metabolic development in different brain regions remains not well understood. This review brings together studies using MRI to look at brain blood flow and proton magnetic resonance spectroscopy (¹H-MRS) in preterm infants to suggest a combined view of blood flow and metabolic factors. It covers studies of blood flow using arterial spin labeling and phase-contrast MRI and Doppler methods and studies checking compounds like N-acetylaspartate and choline and creatine and glutamate and GABA, sorted by brain areas. It shows that areas with different or unstable blood flow compared to full-term births often match with areas having slower metabolic growth. Periventricular and supratentorial white matter showed less blood flow and lower N-acetylaspartate with higher choline. Deep gray matter had changed flow along with less glutamate and GABA. The cerebellum showed both clear blood flow issues and metabolic problems, with hints that early nutritional help might change neurometabolic development. These results support a model where unstable brain blood flow limits metabolic growth during key brain development times. Mixing blood flow and metabolic signs might better predict risks early and help understand preterm brain development issues beyond physical injury alone.