Characterization of aperiodic and theta activity in preterm infants using EEG: Insights into cerebral maturation and inter-individual variability

Disrupting critical processes of brain development, preterm birth interferes with the maturation of brain networks and functional activity, including theta oscillations that are thought to play a key role in early network formation. Traditional EEG spectral analyses have indicated marked development of theta power in early infancy, but these approaches mix oscillatory and non-oscillatory activity, limiting insights into the mechanisms underlying the neural changes. Using spectral parameterization, we aimed to evaluate developmental changes in aperiodic activity and periodic theta power in infants born very preterm compared to full-terms, and to further explore whether clinical factors and brain microstructure could explain the inter-individual variability within preterms. High-density EEG was acquired during active/REM sleep at term-equivalent age (TEA) and 2 months corrected age (2mCA) in 41 very preterm infants (born <32 weeks gestational age [GA]; mean ± standard deviation: 26.9±1.7 weeks) and 13 full-term controls (born ≥37 weeks GA; 40.1±1 weeks). Spectral parameterization was used to extract aperiodic components (offset, exponent) and periodic theta power globally and across spatial clusters of electrodes (anterior, central, posterior). From TEA to 2mCA, offset, exponent, and theta power increased with no differences between preterm and full-term infants. At TEA, metrics of aperiodic activity were stronger in anterior compared with posterior areas, but this regional landscape shifted by 2mCA with pronounced increases in aperiodic offset and exponent in posterior areas from TEA to 2mCA. Within preterms, inter-individual variability in aperiodic and periodic activity at TEA was partly explained by clinical risk factors: male sex, lower gestational-age at birth, small weight at birth, and invasive ventilation were linked to alterations of aperiodic offset, exponent and theta power. Additionally, higher theta power at TEA correlated with lower cortical fractional anisotropy assessed with diffusion MRI at the same age, consistently with more advanced maturation of the brain. Collectively, these findings indicate that EEG spectral parameterization combined with spatial analysis provides a sensitive framework for characterizing the postnatal maturation of brain activity in infants, as well as early vulnerabilities associated with prematurity and perinatal adversity.