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Hemodynamic Risk Factors for Cerebellar Hemorrhage Presence and Volume in Infants Born Very Preterm
Marta Ybarra1, Thiviya Selvanathan2, Ting Guo3
1Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Department of Neonatology, La Paz University Hospital, Madrid, Spain.
Insights
Hypotension treated with inotropes is a significant risk factor for cerebellar hemorrhage (CbH) in very preterm infants. Managing hypotension is crucial for preventing CbH and improving neurodevelopmental outcomes.
Area of Science:
- Neonatal neurology
- Pediatric cardiology
- Neurocritical care
Background:
- Cerebellar hemorrhage (CbH) is a serious complication in very preterm infants.
- Hemodynamic disturbances may play a role in CbH development.
- Cardiovascular instability's association with CbH volume requires further investigation.
Purpose of the Study:
- To investigate the link between hemodynamic disturbances and cerebellar hemorrhage (CbH) in very preterm infants.
- To determine if cardiovascular instability correlates with larger CbH volumes.
- To identify risk factors for CbH in this vulnerable population.
Main Methods:
- A prospective, longitudinal, multisite cohort study involving 309 very preterm infants.
- Brain MRI at early-life and/or term-equivalent age.
- Assessment of hemodynamic stability using Score for Neonatal Acute Physiology, treated patent ductus arteriosus, and inotrope-treated hypotension.
Main Results:
- Cerebellar hemorrhage (CbH) occurred in 18.3% of infants.
- Hypotension requiring inotropes was an independent risk factor for CbH (OR 3.07).
- Inotrope-treated hypotension was associated with larger CbH volumes (P < .001).
Conclusions:
- Hypotension requiring inotropes is a significant independent risk factor for both the presence and volume of CbH.
- Maintaining hemodynamic stability, particularly managing hypotension, is vital for preventing CbH.
- Effective hypotension management may improve neurodevelopmental outcomes in very preterm infants.
Objective:
To examine among infants born very preterm the role of hemodynamic disturbances in the occurrence of cerebellar hemorrhage (CbH) and whether cardiovascular instability is associated with larger CbH volume.
Study Design:
Prospective, longitudinal, multisite cohort study. Early-life and/or term-equivalent age brain magnetic resonance imaging were performed in 309 very preterm infants admitted to 3 tertiary-level neonatal intensive care units. A cut-off of 4 mm was used to distinguish punctate vs large CbH. CbH volumes were obtained by manual segmentation. As a measure of hemodynamic stability, Score for Neonatal Acute Physiology, patent ductus arteriosus requiring treatment, and hypotension treated with inotropes were recorded.
Results:
Sixty patients (18.3%) were diagnosed with CbH, classified as punctate in 43 infants (71.3%). Hypotension requiring treatment with inotropes was an independent risk factor for CbH (OR 3.07, 95% CI 1.15-8.21, P = .02) and was associated with larger CbH volume (0.36 log mm3, 95% CI 0.17-0.54, P < .001).
Conclusions:
Hypotension treated with inotropes is shown to be an independent risk factor for the presence of CbH as well as for larger CbH volume. These results reinforce the importance of hemodynamics stability, especially an appropriate management of hypotension to prevent CbH and therefore improve neurodevelopmental outcomes among infants born very preterm.
