The Impacts of Enlarged Subarachnoid Space on Brain Growth and Cortex Maturation in Very Preterm Infants

Objectives: The aim of this study is to investigate the changes in quantitative indices of brain volume and cortex development in preterm infants with enlarged subarachnoid space (ESS). Methods: A single-center retrospective cohort study was performed in Hong Kong University-Shenzhen Hospital from November 2014 to November 2023, involving 200 preterm infants whose brain MRI images were available. Parameters including the volume of cerebrospinal fluid (CSF), brain tissues, total intracranial cavity (ICC), and key indices of cortex maturation (surface area, cortical thickness, cortical volume, mean curvature) were compared between the groups with ESS and without ESS. The retrospective nature of this study may introduce selection bias in the process of enrolling preterm infants with ESS. Results: The groups with severe and mild ESS had a significantly greater ICC volume than the group without ESS (severe: 384.66 ± 30.33 [p < 0.001]; mild: 374.25 ± 26.45 [p < 0.001] vs. no ESS: 356.78 ± 26.03), and the difference was mostly due to the gap in extra-CSF volume among the three groups (severe: 74.20 ± 5.1 and mild: 55.36 ± 3.8 vs. no ESS: 40.54 ± 4.3, p ≤ 0.001). Only the volume of parenchyma of the severe-ESS group was significantly different (severe: 302.35 ± 26.43 vs. no ESS: 312.27 ± 20.75, p = 0.003). Regarding indices of cortex maturation, only the mean curvature showed a significant difference between the three groups, and most of the significant clusters were located around the parietal and temporal lobes. Conclusions: ESS may be associated with impaired early brain maturation in preterm infants after birth. A further neurodevelopmental follow-up study is needed.