Reduced Cerebellar Size at Term-Equivalent Age Is Related to a 17% Lower Mental Developmental Index in Very Preterm Infants without Brain Injury

Abstract

<b><i>Introduction:</i></b> Cerebellar injury is increasingly recognized as a relevant complication of premature birth. However, the prevalence of reduced cerebellar growth and its consequences for neurodevelopmental outcome in preterm infants without overt brain injury remain to be defined in detail. The aim of this study was to assess the transcerebellar diameter (TCD) at term-equivalent age (TEA) in very preterm infants without brain injury and to evaluate whether TCD is related to neurodevelopmental outcome in this population. <b><i>Methods:</i></b> Very preterm infants underwent magnetic resonance imaging at TEA. Infants with any grade of supra- or infratentorial brain injury were excluded. TCD was measured and categorized using existing cut-off values as normal TCD and mild or severe TCD reduction. Psychomotor Developmental index (PDI) and Mental Developmental index (MDI) were assessed using Bayley Scales of Infant Development II and III at a corrected age of 2 years. <b><i>Results:</i></b> A total of 166 infants with a mean gestational age of 29.9 ± 1.8 weeks and a mean birth weight of 1,317 ± 393 g were included. Mean TCD of girls was significantly lower compared to the mean TCD of boys (<i>p</i> = 0.004). TCD reduction was present in 8 infants (4.8%). Infants with a mild TCD reduction achieved lower mean MDI than infants with normal TCD (<i>p</i> = 0.021). <b><i>Discussion:</i></b> We found that reduced TCD was associated with a 17% lower mean MDI at a corrected age of 2 years. Thus, TCD at TEA may be used as an imaging marker for adverse cognitive outcome in the apparently low-risk group of preterm infants without brain injury.

Supratentorial Brain Metrics Predict Neurodevelopmental Outcome in Very Preterm Infants without Brain Injury at Age 2 Years

“…Cognitive and motor functions are often compromised by brain injury, which affects 25% of all very preterm infants [2,3]. Nevertheless, some infants without brain in-DOI: 10.1159/000506836 jury such as intraventricular/cerebellar haemorrhage or periventricular white matter injury visible on conventional magnetic resonance imaging (MRI) at term-equivalent age (TEA) are also affected by adverse outcome [4]. Recently, we demonstrated that in infants without ostensible brain injury a reduced cerebellar size at TEA is related to a lower Mental Developmental Index (MDI) at 2 years of age [4].…”

“…Nevertheless, some infants without brain in-DOI: 10.1159/000506836 jury such as intraventricular/cerebellar haemorrhage or periventricular white matter injury visible on conventional magnetic resonance imaging (MRI) at term-equivalent age (TEA) are also affected by adverse outcome [4]. Recently, we demonstrated that in infants without ostensible brain injury a reduced cerebellar size at TEA is related to a lower Mental Developmental Index (MDI) at 2 years of age [4]. Conversely, we found no significant relationship between cerebellar size and Psychomotor Developmental Index (PDI), and there are still infants at risk for adverse outcome who go undetected [4].…”

“…Recently, we demonstrated that in infants without ostensible brain injury a reduced cerebellar size at TEA is related to a lower Mental Developmental Index (MDI) at 2 years of age [4]. Conversely, we found no significant relationship between cerebellar size and Psychomotor Developmental Index (PDI), and there are still infants at risk for adverse outcome who go undetected [4]. This poses the challenge to find other imaging markers for adverse outcome in order to sift out those allegedly healthy infants early and offer them timely support.…”

Systemic multipotent adult progenitor cells protect the cerebellum after asphyxia in fetal sheep

“…2 However, previous findings demonstrate that cerebellar injury plays an important role in the high prevalence of nonmotor deficits (ie, cognition, learning, and behavior) in survivors of prematurity. 3,4 During the third trimester of pregnancy, the cerebellum exhibits a rapid increase in growth and development. 2 Any disturbance of cerebellar growth, for example, by hypoxia-ischemia or inflammation, may lead to irreversible aberrations of the cerebellar integrity.…”

“…HIE was recognized primarily as a white matter disease of the cerebrum, leaving cerebellar involvement underappreciated in the clinical setting 2 . However, previous findings demonstrate that cerebellar injury plays an important role in the high prevalence of nonmotor deficits (ie, cognition, learning, and behavior) in survivors of prematurity 3,4 …”