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Published on: August 25, 2022
The effects of mild germinal matrix-intraventricular haemorrhage on the developmental white matter microstructure of
Domenico Tortora1, Carola Martinetti1, Mariasavina Severino2
1Neuroradiology Unit, Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5, 16147, Genoa, Italy.
Objectives:
To evaluate white matter (WM) microstructural changes in preterm neonates (PN) with mild germinal matrix-intraventricular haemorrhage (mGMH-IVH) (grades I and II) and no other associated MRI abnormalities, and correlate them with gestational age (GA) and neurodevelopmental outcome.
Methods:
Tract-based spatial-statistics (TBSS) was performed on DTI of 103 patients studied at term-equivalent age, to compare diffusional parameters (fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), axial diffusivity (AD)) between mGMH-IVH neonates (24/103) and controls matched by GA at birth and sex. The relationship between DTI abnormalities, GA and neurodevelopmental outcome assessed with Griffiths' Developmental Scale-Revised:0-2 was explored using TBSS and Spearman-correlation analysis (p < .05).
Results:
Affected neonates had lower FA, higher RD and MD of the corpus callosum, limbic pathways and cerebellar tracts. Extremely preterm neonates (GA < 29 weeks) presented more severe microstructural impairment (higher RD and MD) in periventricular regions. Neonates of GA ≥ 29 weeks had milder WM alterations (lower FA), also in subcortical WM. DTI abnormalities were associated with poorer locomotor, eye-hand coordination and performance outcomes at 24 months.
Conclusions:
WM microstructural changes occur in PN with mGMH-IVH with a GA-dependent selective vulnerability of WM regions, and correlate with adverse neurodevelopmental outcome at 24 months.
Key Points:
• DTI-TBSS analysis identifies WM microstructural changes in preterm neonates with mGMH-IVH. • Extremely preterm neonates with mGMH-IVH presented more severe impairment of WM microstructure. • Extremely preterm neonates with mGMH-IVH presented microstructural impairment of periventricular WM. • mGMH-IVH affects subcortical WM in preterm neonates with gestational age ≥ 29 weeks. • WM microstructural alterations are related to neurodevelopmental impairments at 24 months.
Insights
Mild germinal matrix-intraventricular haemorrhage (mGMH-IVH) in preterm infants causes white matter (WM) changes. These microstructural alterations correlate with gestational age and impact neurodevelopmental outcomes at 24 months.
Area of Science:
- Neuroimaging
- Neonatal Neurology
- Developmental Neuroscience
Background:
- Preterm neonates (PN) with mild germinal matrix-intraventricular haemorrhage (mGMH-IVH) (grades I and II) may experience white matter (WM) microstructural changes.
- Assessing these changes is crucial for understanding long-term neurodevelopmental impacts.
Purpose of the Study:
- To evaluate WM microstructural changes in PN with mGMH-IVH.
- To correlate these changes with gestational age (GA) and neurodevelopmental outcomes.
Main Methods:
- Diffusion Tensor Imaging (DTI) and Tract-Based Spatial Statistics (TBSS) were used to analyze WM microstructure in 103 neonates at term-equivalent age.
- Diffusional parameters (FA, MD, RD, AD) were compared between 24 mGMH-IVH neonates and matched controls.
- Spearman correlation analysis explored relationships between DTI abnormalities, GA, and neurodevelopmental outcomes using Griffiths' Developmental Scale-Revised:0-2.
Main Results:
- Neonates with mGMH-IVH showed reduced fractional anisotropy (FA) and increased radial diffusivity (RD) and mean diffusivity (MD) in the corpus callosum, limbic pathways, and cerebellar tracts.
- Extremely preterm neonates (GA < 29 weeks) exhibited more severe microstructural impairment (higher RD, MD) in periventricular regions.
- Neonates with GA ≥ 29 weeks had milder WM alterations (lower FA) in subcortical WM.
- DTI abnormalities correlated with poorer locomotor, eye-hand coordination, and performance outcomes at 24 months.
Conclusions:
- WM microstructural changes are present in preterm neonates with mGMH-IVH.
- These changes demonstrate a gestational age-dependent vulnerability in specific WM regions.
- WM microstructural alterations are associated with adverse neurodevelopmental outcomes at 24 months.
