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Differential effects of intraventricular hemorrhage and white matter injury on preterm cerebellar growth
Emily W Y Tam1, Steven P Miller, Colin Studholme
1Department of Neurology, University of California San Francisco, CA, USA.
Insights
Severe intraventricular hemorrhage (IVH) in preterm infants significantly slows cerebellar growth. This reduced cerebellar volume may stem from direct injury or blood effects, impacting brain development.
Area of Science:
- Neonatal neurology
- Pediatric neuroimaging
- Developmental neuroscience
Background:
- Preterm infants are at high risk for brain injury, including intraventricular hemorrhage (IVH) and white matter injury.
- The cerebellum plays a crucial role in motor development and cognitive functions, and its growth in early life is critical.
- Understanding the impact of early brain injury on cerebellar development is essential for predicting long-term outcomes.
Purpose of the Study:
- To investigate the association between early cerebellar volume changes and the presence of intraventricular hemorrhage (IVH) in preterm infants.
- To determine if white matter injury severity correlates with alterations in cerebellar growth patterns.
- To quantify the impact of different grades and locations of IVH on cerebellar volume development over time.
Main Methods:
- Serial magnetic resonance imaging (MRI) scans were acquired near birth and near term-equivalent age in preterm newborns.
- Interactive semi-automated tools were employed to accurately measure cerebellar hemisphere volumes.
- Statistical analyses adjusted for confounding factors such as supratentorial brain injury, cerebellar hemorrhage, and study site.
Main Results:
- Cerebellar volume demonstrated significant growth of 1.7 cm³/week postmenstrual age, independent of injury severity.
- More severe grades of supratentorial IVH were strongly associated with significantly slower cerebellar volume growth (P < .001).
- Infants with grade 1-2 IVH had 1.4 cm³ less cerebellar volume, while those with grade 3-4 IVH had 5.4 cm³ less volume by 40 weeks.
Conclusions:
- Decreased cerebellar volume in preterm infants is significantly associated with the presence and severity of supratentorial IVH.
- The findings suggest that early cerebellar volume deficits may result from direct cerebellar injury or the toxic effects of subarachnoid blood.
- No significant association was found between the severity of white matter injury and altered cerebellar growth patterns.
Objective:
To hypothesize that detailed examination of early cerebellar volumes in time would distinguish differences in cerebellar growth associated with intraventricular hemorrhage (IVH) and white matter injury in preterm infants.
Study Design:
Preterm newborns at the University of California San Francisco (n = 57) and the University of British Columbia (n = 115) were studied with serial magnetic resonance imaging scans near birth and again at near term-equivalent age. Interactive semi-automated tools were used to determine volumes of the cerebellar hemispheres.
Results:
Adjusting for supratentorial brain injury, cerebellar hemorrhage, and study site, cerebellar volume increased 1.7 cm(3)/week postmenstrual age (95% CI, 1.6-1.7; P < .001). More severe supratentorial IVH was associated with slower growth of cerebellar volumes (P < .001). Volumes by 40 weeks were 1.4 cm(3) lower in premature infants with grade 1 to 2 IVH and 5.4 cm(3) lower in infants with grade 3 to 4 IVH. The same magnitude of decrease was found between ipsilateral and contralateral IVH. No association was found with severity of white matter injury (P = .3).
Conclusions:
Early effects of decreased cerebellar volume associated with supratentorial IVH in either hemisphere may be a result of concurrent cerebellar injury or direct effects of subarachnoid blood on cerebellar development.
