Purpose
To evaluate white matter development in extremely low birth weight (ELBW) infants with or without previous brain hemorrhage.
Methods
Thirty-three ELBW infants were prospectively enrolled and included in this IRB approved study. Another 10 healthy term infants were included as controls. The medical records of the ELBW infants were reviewed for ultrasound diagnosis of intraventricular hemorrhage (IVH). All infants had an MRI examination at term-equivalent age for detection of previous hemorrhage, and their white matter was scored and compared among different groups. DTI measured fractional anisotropy (FA) values were also compared voxel-wise by tract-based-spatial-statistics (TBSS).
Results
Compared to controls, the white matter score was not significantly different in ELBW infants without blood deposition on MRI (p=0.17), but was significantly worse in ELBW infants with blood deposition on MRI but no IVH diagnosis by ultrasound (p=0.02), in ELBW infants with grade 1 or 2 IVH on ultrasound (p=0.003), and in ELBW infants with grade 3 or 4 IVH on ultrasound (p=0.0001).ELBW infants without blood deposition on MRI did not show any white matter regions with significantly lower FA values than controls. ELBW infants with blood deposition on MRI but no IVH diagnosis did show white matter regions with significantly lower FA,and ELBW infants with IVH diagnosis had widespread white matter regions with lower FA.
Conclusions
Previous brain hemorrhage is associated with abnormal white matter in ELBW infants at term-equivalent age, and ultrasound is not sensitive to minor hemorrhages that are sufficient to cause white matter injury.