Glymphatic System in Preterm Neonates: Developmental Insights Following Birth Asphyxia

Area of Science:

• Neonatal Neurology
• Neurodevelopmental Biology
• Pediatric Imaging

Background:

• Birth asphyxia (BA) and germinal matrix hemorrhage-intraventricular hemorrhage (GMH-IVH) are prevalent in preterm neonates.
• The impact of BA and GMH-IVH on the developing glymphatic system (GS) in preterm infants is not well understood.

Purpose of the Study:

• To characterize the developmental trajectory of the glymphatic system in preterm neonates.
• To investigate the influence of BA and GMH-IVH on glymphatic system function.

Main Methods:

• Prospective study utilizing two independent datasets (internal and dHCP) of preterm neonates.
• 3.0T MRI with diffusion-weighted spin-echo planar imaging was used.
• Diffusion along the perivascular space (DTI-ALPS) index was calculated to assess GS function.

Main Results:

• Preterm neonates with BA showed a significantly lower DTI-ALPS index compared to those without BA.
• GMH-IVH did not demonstrate a significant effect on the DTI-ALPS index.
• The DTI-ALPS index increased significantly from 25 to 34 weeks postmenstrual age, then plateaued.

Conclusions:

• Birth asphyxia, not GMH-IVH, is a primary factor affecting glymphatic system development in preterm neonates.
• Glymphatic system development follows a nonlinear pattern.
• Close monitoring of GS development is recommended for preterm neonates with a gestational age under 34 weeks.