Influence of cerebellar hemorrhage in very preterm infants with intraventricular hemorrhage in relation to neurodevelopmental outcome

Background and Aim Intraventricular hemorrhage (IVH) is a common pathology in patients born before 32 weeks gestational age (GA). It is caused by peri- and postnatal factors and results from hemorrhage in the region of the germinal matrix. From a pathophysiologic point of view similar factors are involved in cerebellar hemorrhages (CBH). As the cerebellum is very important for motoric and cognitive functions, the aim of our study was to analyze the impact of CBH on outcome at two years of age in preterm infants with IVH.

Methods All infants with IVH, who had a magnetic resonance tomography (MRI) at term-equivalent age and Bayley Scales of Infant Development III at two years corrected age, were included. Cerebellar pathologies were analyzed using standardized MRI images including the susceptibility-weighted imaging sequence. Patients were categorized in three groups with no, low-grade (uni- or bilateral microbleeds < 3mm) or high-grade (uni- or bilateral bleeds ≥ 3mm) cerebellar injuries. Analysis were corrected vor IVH grade with linear regression.

Results The study cohort consisted of 97 preterm neonates, with a GA of 25.9 (IQR 24.6, 27.4) weeks and a birthweight of 795 (IQR 620, 958) grams. GA as well as birthweight did not differ between the groups. In this cohort mean IVH grade was 3 (IQR 2, 4) and 47.4% had a neurosurgical intervention. A total of 27 infants had no, 38 low-grade and 32 high-grade CBH.

Motor as well as cognitive outcome at two years corrected age were significantly lower in patients with CBH compared to the patients without CBH (Bayley motor scale: 58 (IQR 45, 82) vs 82 (IQR 70, 92); Bayley cognitive scale: 55 (IQR 55, 80) vs 75 (IQR 55, 100); both p < 0.001). Bayley language scale did not differ between the two groups (CBH [60 (IQR 45, 80)} vs no CBH [72 (IQR 48, 84]; p=0.074).

Conclusion Very preterm infants with IVH and concomitant CBH, diagnosed on MRI at term-equivalent age, showed a significantly impaired motor as well as cognitive outcome at two years of life. Patients with high-grade pathologies showed worse outcome compared to those with low-grade pathologies.

Publication History

Article published online:
06 June 2023