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Effects of Posthemorrhagic Ventricular Dilatation in the Preterm Infant on Brain Volumes and White Matter Diffusion
Margaretha J Brouwer1, Linda S de Vries1, Karina J Kersbergen2
1Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
Insights
Posthemorrhagic ventricular dilatation (PHVD) in preterm infants is linked to reduced deep gray matter and cerebellar volumes, and altered white matter diffusion. Germinal matrix-intraventricular hemorrhage (GMH-IVH) alone did not show these effects.
Area of Science:
- Neonatal neurology
- Neuroimaging
- Developmental neuroscience
Background:
- Germinal matrix-intraventricular hemorrhage (GMH-IVH) is a common complication in preterm infants.
- Posthemorrhagic ventricular dilatation (PHVD) can develop following GMH-IVH, potentially impacting brain development.
- Understanding the distinct effects of GMH-IVH and PHVD is crucial for targeted interventions.
Purpose of the Study:
- To compare the effects of GMH-IVH and PHVD on brain and cerebrospinal fluid (CSF) volumes.
- To assess the impact of GMH-IVH and PHVD on white matter diffusion characteristics.
- To evaluate these effects at term-equivalent age (TEA) in preterm infants.
Main Methods:
- A case-control study involving preterm infants (gestational age <31 weeks) with GMH-IVH grade II-III and PHVD requiring intervention.
- Comparison groups included infants with GMH-IVH grade II without PHVD and infants without GMH-IVH.
- Magnetic resonance imaging (MRI) at TEA assessed brain tissue volumes, CSF volumes, and apparent diffusion coefficients (ADCs) in white matter and cerebellum.
Main Results:
- PHVD was significantly associated with reduced deep gray matter and cerebellar volumes.
- PHVD was also linked to increased ventricular and extracerebral CSF volumes.
- Increased white matter ADC values were observed in infants with PHVD, indicating altered diffusion.
Conclusions:
- PHVD, even after intervention, negatively impacts deep gray matter and cerebellar volumes and alters white matter microstructure.
- GMH-IVH alone, without significant PHVD, did not demonstrate these adverse effects on brain volumes or diffusion at TEA.
- These findings highlight PHVD as a distinct pathological entity with significant neurodevelopmental consequences in preterm infants.
Objective:
To evaluate the differential impact of germinal matrix-intraventricular hemorrhage (GMH-IVH) and posthemorrhagic ventricular dilatation (PHVD) on brain and cerebrospinal fluid (CSF) volumes and diffusion variables in preterm born infants at term-equivalent age (TEA).
Study Design:
Nineteen infants (gestational age <31 weeks) with GMH-IVH grade II-III according to Papile et al and subsequent PHVD requiring intervention were matched against 19 controls with GMH-IVH grade II but no PHVD and 19 controls without GMH-IVH. Outcome variables on magnetic resonance imaging (MRI) including diffusion weighted imaging at TEA were volumes of white matter, cortical gray matter, deep gray matter, brainstem, cerebellum, ventricles, extracerebral CSF, total brain tissue, and intracranial volume (ICV), as well as white matter and cerebellar apparent diffusion coefficients (ADCs). Effects of GMH-IVH and PHVD on TEA-MRI measurements were evaluated using multivariable regression analysis. Brain and CSF volumes were adjusted for ICV to account for differences in bodyweight at TEA-MRI and ICV between cases and controls.
Results:
PHVD was independently associated with volumes of deep gray matter (β [95% CI]: -1.4 cc [-2.3; -.5]), cerebellum (-2.7 cc [-3.8; -1.6]), ventricles (+12.7 cc [7.9; 17.4]), and extracerebral CSF (-11.2 cc [-19.2; -3.3]), and with ADC values in occipital, parieto-occipital, and parietal white matter (β: +.066-.119×10(-3) mm(2)/s) on TEA-MRI (P < .05). No associations were found between GMH-IVH grade II-III and brain and CSF volumes or ADC values at TEA.
Conclusions:
PHVD was negatively related to deep gray matter and cerebellar volumes and positively to white matter ADC values on TEA-MRI, despite early intervention for PHVD in the majority of the infants. These relationships were not observed for GMH-IVH.
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