Cerebellar Hemorrhage in the Preterm Infant: Ultrasonographic Findings and Risk Factors

Limperopoulos, Catherine; Benson, Carol B.; Bassan, Haim; DiSalvo, D N; Kinnamon, Daniel D.; Moore, Marianne; Ringer, Steven A.; Volpe, Joseph J.; Plessis, Adré J. du

doi:10.1542/peds.2005-0556

Cited by 217 publications

(218 citation statements)

References 36 publications

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“…Identified risk factors for high-grade PVL, IVH, or any grade of CBH are similar to those described in previous studies. 16,[26][27][28] and are consistent with our pathophysiological understanding of these forms of injury in the preterm brain. 29 However, of importance, less severe injuries in any category, which were more frequently observed in our cohorts, also affect neurodevelopmental outcome, but to a lesser degree, at least to age 2 years.…”

Section: Discussionsupporting

confidence: 79%

Brain Injury and Altered Brain Growth in Preterm Infants: Predictors and Prognosis

et al. 2014

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Brain Injury and Altered Brain Growth in Preterm Infants: Predictors and PrognosisWHAT'S KNOWN ON THIS SUBJECT: Term MRI can assist in identifying the nature and extent of brain injury in preterm infants. However, brain injury detected by MRI does not fully account for neurodevelopmental impairments, particularly cognitive and behavioral impairments, common in preterm survivors. WHAT THIS STUDY ADDS:In addition to brain injury, an assessment of brain growth by using one-dimensional measurements on MRI is helpful for predicting neurodevelopment. Two different patterns of impaired brain growth are observed that relate independently to early cognitive development in preterm infants. abstract BACKGROUND: To define the nature and frequency of brain injury and brain growth impairment in very preterm (VPT) infants by using MRI at term-equivalent age and to relate these findings to perinatal risk factors and 2-year neurodevelopmental outcomes.METHODS: MRI scans at term-equivalent age from 3 VPT cohorts (n = 325) were reviewed. The severity of brain injury, including periventricular leukomalacia and intraventricular and cerebellar hemorrhage, was graded. Brain growth was assessed by using measures of biparietal width (BPW) and interhemispheric distance. Neurodevelopmental outcome at age 2 years was assessed across all cohorts (n = 297) by using the Bayley Scales of Infant Development, Second Edition (BSID-II) or Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III), and evaluation for cerebral palsy. RESULTS:Of 325 infants, 107 (33%) had some grade of brain injury and 33 (10%) had severe injury. Severe brain injury was more common in infants with lower Apgar scores, necrotizing enterocolitis, inotropic support, and patent ductus arteriosus. Severe brain injury was associated with delayed cognitive and motor development and cerebral palsy. Decreased BPW was related to lower gestational age, inotropic support, patent ductus arteriosus, necrotizing enterocolitis, prolonged parenteral nutrition, and oxygen at 36 weeks and was associated with delayed cognitive development. In contrast, increased interhemispheric distance was related to male gender, dexamethasone use, and severe brain injury. It was also associated with reduced cognitive development, independent of BPW.CONCLUSIONS: At term-equivalent age, VPT infants showed both brain injury and impaired brain growth on MRI. Severe brain injury and impaired brain growth patterns were independently associated with perinatal risk factors and delayed cognitive development. Pediatrics 2014;134:e444-e453 Dr Kidokoro contributed to the study concept and design, assessed the MRI findings, performed the statistical analyses, and wrote the first draft of the manuscript; Drs Anderson and Doyle contributed to the collection of the Australian data presented in this article and revised the manuscript for important intellectual content; Dr Woodward contributed to the collection of the New Zealand data presented in this article and revised the manuscript for important i...

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Section: Discussionsupporting

confidence: 79%

Brain Injury and Altered Brain Growth in Preterm Infants: Predictors and Prognosis

et al. 2014

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“…Secondary lesions lead to underdevelopment of the cerebellum and are caused by direct (eg, hemosiderin-blood products, glucocorticoid exposure, undernutrition) or indirect (impaired transsynaptic trophic effects) effects on the cerebellum (86). General perinatal risk factors for cerebellar injury in extremely premature neonates include prolonged ventilation, pressor support, posthemorrhagic hydrocephalus, and infratentorial hemosiderin deposition (84,87). Surviving preterm neonates with cerebellar injuries have a high prevalence of motor, cognitive, and behavioral disabilities, including autistic features (86).…”

Section: Cerebellar Disruption or Injury Secondary To Prematuritymentioning

confidence: 99%

Congenital Abnormalities of the Posterior Fossa

Bosemani¹,

Orman²,

Boltshauser³

et al. 2015

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“…The cerebellum is increasingly recognized as an important structure not only for motor control but also for cognitive and behavioral development. Abnormalities due to hemorrhage and infarction and poor growth [18][19][20] have gone under recognized. Scanning through the posterior fontanel (junction of the lambdoid and sagittal sutures) and mastoid fontanel (junction of the posterior parietal, temporal and occipital bones) can help to detect lesions and structural malformations in these areas [21,22,23,24].…”

Section: Patient and Methodsmentioning

confidence: 99%

Cranial Ultrasonographic Application in Preterm Baby as a Predictive for White Matter Insult

Eid¹

2013

IJMI

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Abstract:Cranial Ultrasound is the most available and easily repeatable technique for imaging the neonatal brain. The quality and diagnostic accuracy depend on various factors; the suitability of the Ultrasound machine for neonatal cranial work, the use of optimal settings and probes, appropriate scanning protocols, the use of a variety of acoustic windows and last but not the least the scanning experience of the examiner. Knowledge of normal anatomy and the echogenicities of different tissues in normal and pathological situations as well as familiarity with the physiological and pathological processes likely to be encountered are vital. This paper assesses the value and appropriate use, safety and diagnostic accuracy of Ultrasound in evaluating the brain of the preterm born infants. This study group consisted of 308 preterm neonates, the gestational ages at birth ranged from 26 weeks to 34 weeks, and the birth weights ranged from 650 grams to 2250 grams, underwent cranial ultrasound in neonatal intensive care unit (NICU). 31 premature neonates were found to have PVL. Type of delivery, presence of perinatal asphyxia, gestation age and birth weight, were statistically insignificantly associated with PVL. Chorioamnionitis and neonatal sepsis and mechanical ventilation > 72 hours were the statistically significantly factors associated with PVL injury.

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Cerebellar Hemorrhage in the Preterm Infant: Ultrasonographic Findings and Risk Factors

Abstract: CBH is an important complication of extreme preterm birth and has been underrecognized in surviving preterm infants. Predictors of CBH seem to be multifactorial and include combined maternal, intrapartum, and early postnatal factors.

Cited by 217 publications

References 36 publications

Brain Injury and Altered Brain Growth in Preterm Infants: Predictors and Prognosis

Brain Injury and Altered Brain Growth in Preterm Infants: Predictors and Prognosis

Congenital Abnormalities of the Posterior Fossa

Cranial Ultrasonographic Application in Preterm Baby as a Predictive for White Matter Insult

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