Cerebellar haemorrhage and atrophy in infants born extremely preterm with intraventricular haemorrhage

Julia Buchmayer1, Renate Fuiko1, Patric Kienast2

  • 1Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria.

Insights

Cerebellar haemorrhage (CBH) and atrophy in extremely preterm infants with intraventricular haemorrhage (IVH) significantly impact neurodevelopment. Higher CBH grade correlates with worse cognitive and motor outcomes at two years.

Area of Science:

  • Neonatal neurology
  • Pediatric neurodevelopment
  • Cerebral imaging

Background:

  • Intraventricular haemorrhage (IVH) is a common complication in extremely preterm infants.
  • Cerebellar injury, including haemorrhage (CBH) and atrophy, can occur alongside IVH.
  • The long-term neurodevelopmental impact of CBH and cerebellar atrophy in this population requires further investigation.

Purpose of the Study:

  • To investigate the impact of cerebellar haemorrhage (CBH) and atrophy in infants born extremely preterm with intraventricular haemorrhage (IVH) on neurodevelopment at 2 years of age.
  • To determine if CBH and cerebellar atrophy are independent predictors of neurodevelopmental outcomes.
  • To explore the relationship between the severity of CBH and neurodevelopmental outcomes.

Main Methods:

  • Retrospective case-control study of infants born at <28 weeks' gestation with IVH over 10 years.
  • Magnetic resonance imaging (MRI) used to assess CBH and cerebellar size.
  • Multivariable regression analysis applied to evaluate neurodevelopmental outcomes at 2 years' corrected age.

Main Results:

  • 67% of 103 infants had CBH (median grade 1).
  • CBH was significantly associated with impaired cognitive and motor outcomes, and cerebral palsy.
  • Cerebellar atrophy (29.1%) correlated with worse outcomes, while increased cerebellar size was linked to improved motor development.

Conclusions:

  • Infants with extremely preterm IVH and CBH show significant cognitive and motor impairments.
  • Developmental delay severity correlates with CBH grade.
  • Findings can aid in predicting long-term outcomes and parental counseling.
Abstract

Related Concept Videos

Cerebral Edema ll: Pathophysiology01:22

Cerebral Edema ll: Pathophysiology

Vasogenic edema is a major form of cerebral edema characterized by abnormal accumulation of fluid in the brain’s extracellular space due to disruption of the blood–brain barrier (BBB). The BBB is a specialized structure composed of endothelial cells connected by tight junctions, supported by astrocytic endfeet and a basement membrane. Under normal conditions, it tightly regulates the movement of ions, proteins, and solutes between the bloodstream and brain parenchyma. When this barrier loses...
Increased Intracranial Pressure ll: Pathophysiology01:29

Increased Intracranial Pressure ll: Pathophysiology

Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins with...
Hemorrhagic Stroke l: Introduction01:17

Hemorrhagic Stroke l: Introduction

A hemorrhagic stroke is an acute neurological event that occurs when a weakened cerebral blood vessel ruptures, allowing blood to accumulate within or around the brain. The sudden release of blood forms a focal hematoma that increases intracranial pressure, displaces neural tissue, and can obstruct cerebrospinal fluid pathways. These effects may be compounded by intraventricular extension of the hemorrhage, cerebral edema, or compression of adjacent structures, all of which contribute to...
Cerebral Edema l: Introduction01:19

Cerebral Edema l: Introduction

Cerebral edema is a pathological increase in brain water content that disrupts intracranial pressure regulation and impairs neurological function. Because the cranial vault is rigid, even modest increases in tissue volume can compromise cerebral perfusion, distort neural structures, and initiate secondary injury. Cerebral edema develops through four principal mechanisms: vasogenic, cytotoxic, interstitial, and ionic.Vasogenic EdemaVasogenic edema arises from disruption of the blood–brain...
Hemorrhagic Stroke ll: Pathophysiology01:29

Hemorrhagic Stroke ll: Pathophysiology

A hemorrhagic stroke develops when a cerebral blood vessel ruptures, allowing blood to escape into the surrounding brain tissue, as in intracerebral hemorrhage (ICH), or into the subarachnoid space, as in subarachnoid hemorrhage (SAH). Because the skull is a rigid compartment, the sudden presence of extravascular blood rapidly increases intracranial pressure and compresses adjacent neural structures, leading to immediate tissue injury and impaired cerebral perfusion.Mass Effect and Primary...
Cerebellum: Anatomical Regions01:17

Cerebellum: Anatomical Regions

The cerebellum, also known as the "little brain," is located in the posterior cranial fossa, inferior to the tentorium cerebelli and dorsal to the brainstem. It plays a significant role in motor control, coordination, and proprioception.
Cerebellar Structure
Externally, the cerebellum features a highly convoluted surface with numerous folia (narrow ridges) separated by shallow sulci (grooves). The cerebellum is divided into two hemispheres by a thin median structure known as the vermis. The...