Biological epigenetic aging in very preterm newborns holds potential as an indicator of brain growth and poor neurodevelopmental outcomes, a study appearing in JAMA Network Open suggests. Generally, the extent of prematurity is used by clinicians to predict neurodevelopment in children born very preterm, but studies indicate that prematurity alone cannot fully explain alterations in the neonatal brain. As such, there is a need for ways to assess these children that extend beyond standard clinical factors and medical assessments. In this week's study, a team led by scientists from the Hospital for Sick Children in Toronto examined neuroimaging data from 35 very preterm infants and compared them with the results of the pediatric buccal epigenetic clock (PedBE), a tool that measures DNA methylation at 94 age-informative CpG sites using buccal swab samples. They find that accelerated epigenetic aging was associated with smaller brain volumes and slower brain growth, as well as worse neurodevelopmental outcomes at 18 months of age. "Our work provides a step forward in integrative approaches that can be used to tailor precision health tools and interventions that aim to identify and target very preterm neonates at high risk of impaired neurodevelopment along the life course," the researchers write