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Low-grade intraventricular hemorrhage disrupts cerebellar white matter in preterm infants: evidence from diffusion
Takashi Morita1, Masafumi Morimoto, Kei Yamada
1Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
Insights
Low-grade intraventricular hemorrhage (IVH) in preterm infants impacts cerebellar and white matter development, particularly in younger infants. This study highlights the damaging effects of even mild IVH on the superior cerebellar peduncle.
Area of Science:
- Neuroimaging
- Neonatal Neurology
- Developmental Neuroscience
Background:
- High-grade intraventricular hemorrhage (IVH) is known to affect cerebellar development in preterm infants.
- The impact of low-grade IVH on cerebellar development remains unclear.
- This study investigates the effects of low-grade IVH on the developing brains of preterm infants.
Purpose of the Study:
- To evaluate the impact of low-grade intraventricular hemorrhage (IVH) on cerebellar and cerebral white matter (WM) development in preterm infants.
- To compare DTI metrics between preterm infants with and without low-grade IVH.
- To assess the influence of gestational age at birth on IVH-related white matter alterations.
Main Methods:
- Diffusion tensor imaging (DTI) tractography was used to analyze 42 preterm infants (<30 weeks GA) at term-equivalent age.
- Infants were categorized based on the presence (n=22) or absence (n=20) of low-grade IVH, diagnosed via cerebral ultrasound or MRI.
- Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were measured in the superior cerebellar peduncle (SCP), middle cerebellar peduncle (MCP), motor tract, and sensory tract.
Main Results:
- Preterm infants with low-grade IVH exhibited lower FA values in the superior cerebellar peduncle (SCP) compared to controls.
- Younger preterm infants with IVH showed reduced FA in the SCP and motor tract, alongside increased ADC in the MCP.
- These findings suggest significant white matter alterations associated with low-grade IVH.
Conclusions:
- Low-grade intraventricular hemorrhage (IVH) negatively impacts cerebellar and cerebral white matter development in preterm infants, particularly affecting the superior cerebellar peduncle (SCP).
- Younger preterm infants demonstrate more pronounced disruptions in cerebellar white matter and motor tracts following low-grade IVH.
- These results underscore the importance of monitoring and potentially intervening in cases of mild IVH to mitigate long-term neurodevelopmental consequences.
Introduction:
Recent diffusion tensor imaging (DTI) studies have demonstrated that leakage of hemosiderin into cerebrospinal fluid (CSF), which is caused by high-grade intraventricular hemorrhage (IVH), can affect cerebellar development in preterm born infants. However, a direct effect of low-grade IVH on cerebellar development is unknown. Thus, we evaluated the cerebellar and cerebral white matter (WM) of preterm infants with low-grade IVH.
Methods:
Using DTI tractography performed at term-equivalent age, we analyzed 42 infants who were born less than 30 weeks gestational age (GA) at birth (22 with low-grade IVH, 20 without). These infants were divided into two birth groups depending on GA, and we then compared the presence and absence of IVH which was diagnosed by cerebral ultrasound (CUS) within 10 days after birth or conventional magnetic resonance imaging (MRI) at term-equivalent age in each group. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) at the superior cerebellar peduncle (SCP), middle cerebellar peduncle (MCP), motor tract, and sensory tract were measured.
Results:
In the SCP, preterm born infants with IVH had lower FA values compared with infants without IVH. In particular, younger preterm birth with IVH had lower FA values in the SCP and motor tract and higher ADC values in the MCP.
Conclusion:
Low-grade IVH impaired cerebellar and cerebral WM, especially in the SCP. Moreover, younger preterm infants exhibited greater disruptions to cerebellar WM and the motor tract than infants of older preterm birth.
