Functional MRI (fMRI) findings in a group of 5 pre-term infants were correlated with a unilateral passive forearm extension/flexion to relate the functional data to structural and behavioral data, in studies at the University of Bonn, Germany; and University Medical Center, Groningen, Netherlands. Measurement of blood oxygen level-dependent (BOLD) responses in the sensorimotor cortex showed bilateral activation during unilateral passive sensorimotor stimulation. The prevailing hemodynamic response was a negative blood oxygenation level-dependent signal. Positive blood oxygenation level-dependent response or failure to activate the sensorimotor cortex was found in patients with abnormal brain structural and behavioral problems. 
COMMENT. The authors propose that their fMRI findings are compatible with a bilaterally distributed sensorimotor system in the preterm infant. The reductions of oxy/deoxy-Hb ratio in activated brain tissue may reflect ineffective neural processing during this maturational stage of rapid synapse formation. Positive blood oxygenation level-dependent responses or failure to activate the sensorimotor cortex in a preterm infant may predict abnormal cerebral development and need for careful follow-up. fMRI should provide a more effective measure of long-term developmental problems than the neonatal neurological exam.