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Modeling Neonatal Intraventricular Hemorrhage Through Intraventricular Injection of Hemoglobin
Published on: August 25, 2022
Impaired white matter development in extremely low-birth-weight infants with previous brain hemorrhage
X Ou1, C M Glasier2, R H Ramakrishnaiah2
1From the Department of Radiology (X.O., C.M.G., R.H.R., T.L.A.), University of Arkansas for Medical Sciences, Little Rock, Arkansas Pediatric Radiology (X.O., C.M.G., R.H.R.), Arkansas Children's Hospital, Little Rock, Arkansas ouxiawei@uams.edu.
Insights
Brain hemorrhage in premature infants impacts white matter development. Even minor bleeds not detected by ultrasound can cause significant white matter injury in extremely low-birth-weight infants.
Area of Science:
- Neonatal neurology
- Neuroimaging
- Developmental neuroscience
Background:
- Brain hemorrhage is a frequent complication in premature infants.
- White matter injury is a primary concern in extremely low-birth-weight (ELBW) neonates.
- Early detection and characterization of white matter abnormalities are crucial for neurodevelopmental outcomes.
Purpose of the Study:
- To evaluate white matter development in ELBW infants.
- To compare white matter integrity in ELBW infants with and without a history of brain hemorrhage.
- To assess the sensitivity of sonography in detecting hemorrhages that affect white matter.
Main Methods:
- Prospective enrollment of 33 ELBW infants and 10 healthy term infants as controls.
- Review of medical records for sonography diagnosis of intraventricular hemorrhage (IVH).
- MR imaging at term-equivalent age for hemorrhage detection and white matter scoring.
- Diffusion tensor imaging (DTI) with tract-based spatial statistics (TBSS) for fractional anisotropy (FA) analysis.
Main Results:
- White matter scores were significantly worse in ELBW infants with hemorrhage (any grade) compared to controls.
- ELBW infants with blood deposition on MRI but no sonography-diagnosed IVH showed reduced FA values.
- Sonography missed minor hemorrhages sufficient to cause white matter injury, as evidenced by MRI findings.
Conclusions:
- Previous brain hemorrhage is linked to abnormal white matter development in ELBW infants at term-equivalent age.
- Sonography has limitations in detecting subtle hemorrhages that can still impact white matter integrity.
- Advanced neuroimaging like MRI and DTI are essential for comprehensive assessment of white matter injury in high-risk neonates.
Background And Purpose:
Brain hemorrhage is common in premature infants. The purpose of the study is to evaluate white matter development in extremely low-birth-weight infants with or without previous brain hemorrhage.
Materials And Methods:
Thirty-three extremely low-birth-weight infants were prospectively enrolled and included in this institutional review board-approved study. Another 10 healthy term infants were included as controls. The medical records of the extremely low-birth-weight infants were reviewed for sonography diagnosis of intraventricular hemorrhage. All infants had an MR imaging examination at term-equivalent age for detection of previous hemorrhage, and their white matter was scored and compared among different groups. DTI measured fractional anisotropy values were also compared voxelwise by tract-based spatial statistics.
Results:
Compared with controls, the white matter score was not significantly different in extremely low-birth-weight infants without blood deposition on MR imaging (P = .17), but was significantly worse in extremely low-birth-weight infants with blood deposition on MR imaging but no intraventricular hemorrhage diagnosis by sonography (P = .02), in extremely low-birth-weight infants with grade 1 or 2 intraventricular hemorrhage on sonography (P = .003), and in extremely low-birth-weight infants with grade 3 or 4 intraventricular hemorrhage on sonography (P = .0001). Extremely low-birth-weight infants without blood deposition on MR imaging did not show any white matter regions with significantly lower fractional anisotropy values than controls. Extremely low-birth-weight infants with blood deposition on MR imaging, but no intraventricular hemorrhage diagnosis, did show white matter regions with significantly lower fractional anisotropy values, and extremely low-birth-weight infants with intraventricular hemorrhage diagnosis had widespread white matter regions with lower fractional anisotropy values.
Conclusions:
Previous brain hemorrhage is associated with abnormal white matter in extremely low-birth-weight infants at term-equivalent age, and sonography is not sensitive to minor hemorrhages that are sufficient to cause white matter injury.
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