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Published on: November 20, 2015
Neurodevelopmental Outcomes of Isolated Cerebellar Pathologies in Extremely Preterm Infants
Julia Buchmayer1, Sophie Stummer1, Renate Fuiko1
1Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care, and Neuropediatrics, Medical University of Vienna, Vienna, Austria, a full member of ERN EpiCARE.
Background And Objectives:
Cerebellar pathologies, especially cerebellar hemorrhage (CBH), in extremely preterm infants has been increasingly detected through cerebral magnetic resonance imaging (cMRI). We evaluated prevalence, associated risk factors, and neurodevelopmental outcomes of isolated CBH in a contemporary cohort of high-risk infants without major supratentorial brain injuries.
Methods:
This observational cohort study included infants born at less than 28 weeks' gestation during 2017-2022 who underwent cMRI at term-equivalent age. Cerebellar pathologies, including low-grade (≤3 mm) and high-grade (>3 mm) hemorrhages, cerebellar atrophy, and vermis hemorrhage, and their impact on outcomes at 2 years' corrected age were analyzed using multivariable regression adjusted for relevant neurodevelopmental covariates. Risk factors for CBH were also examined.
Results:
CBH was identified in 69 of 252 infants without major supratentorial injuries (27.4%; 74% low-grade and 26% high-grade injuries). At 2 years' corrected age, motor composite scores were significantly lower in the CBH group, including low-grade hemorrhage (≤3 mm). Larger hemorrhages and cerebellar atrophy were associated with poorer cognitive and motor performance. Vermian hemorrhages were linked to impaired motor development and higher rates of cerebral palsy. Infants with isolated CBH had lower gestational ages, birth weights, and 1-minute Apgar scores and higher rates of sepsis, patent ductus arteriosus requiring intervention, and high-grade retinopathy of prematurity.
Conclusions:
Extremely preterm infants without supratentorial brain injury with CBH on cMRI demonstrated significantly impaired motor outcomes and higher rates of cerebral palsy at 2 years' corrected age. These findings highlight isolated CBH as an independent risk factor for neurodevelopmental impairment and for refining prognostication.
