Purpose:
Extremely premature infants (EPIs GA 23-27weeks) survive with current advances in neonatology support, yet are known to be at risk for a variety of brain injuries. Little is known about some of the brain injuries affecting EPIs such as cerebellar germinal matrix hemorrhage (GMH), cerebellar injury or white matter injury. Our aim was to review MRI abnormalities of EPIs in comparison to those occurring in very premature infants (VPIs GA 28-31 weeks).
Materials and Methods:
Study is IRB-approved. All consecutive neonates less than 32 weeks GA at birth admitted to the NICU over a 5-year period 2014-2019, were included. All brain MRIs performed for any indication prior to one year of age were reviewed for the presence of posterior fossa hemorrhage, cerebellar volume loss, periventricular white matter volume loss (PVWMVL), and post hemorrhagic hydrocephalus (PHH) by a pediatric neuroradiologist and a pediatric radiologist. Demographic data were extracted from the medical records. A Fisher exact test was used to compare the findings in the EPI and VPI patient groups; P values less than 0.05 were considered significant
Results:
There were 1353 neonates, of whom 210 (16%) had head MRI within the specified period. There were 89 EPIs and 121 VPIs. EPIs had higher rates of cerebellar hemorrhage (22.5% vs 9.9%; p<0.05) and cerebellar volume loss (12.4% vs 0.8%; p<0.05), compared to VPIs. EPIs also had a higher rate of hemosiderosis in the posterior fossa (11.2% vs. 3.3%; p<0.05). The incidence of PVWMVL was also significantly higher in EPIs compared to VPIs (37.1% vs 11.6%; p<0.05). However, rates of PHH were not statistically different between EPIs and VPIs (11.2% vs 7.4%; p = 0.47)
Conclusions:
Cerebellar GMH and cerebellar volume loss occur more frequently in EPIs compared to VPIs, events and phenomena which may affect cerebellar development. PVWMVL also occurs more frequently in EPIs, suggesting a higher sensitivity to periventricular white matter injury, or exposure to greater number and severity of systemic events leading to such injuries. However, the development of post hemorrhagic hydrocephalus shows no significant difference between these two groups of markedly premature infants despite higher incidence of posterior fossa hemosiderosis in EPIs. Documentation and understanding of such brain injuries is important in understanding implications for neurodevelopmental outcomes, and for the development of proactive interventions.

Intracranial Abnormalities at Follow-Up in Extremely Premature Versus Very Premature Infants- An MR Comparison Study

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