Neonatal Neurology Fellow The Hospital for Sick Children York, Ontario, Canada
Background: Cerebellar hemorrhage (CbH) contributes to motor and cognitive disabilities in preterm infants. A complicated neonatal course including hemodynamic disturbances seem to be related to an increased risk for CbH. Objective: To define risk factors related to cardiovascular insufficiency in preterm infants for CbH, Cbh volume and location. Design/Methods: Early-life (median post-menstrual age [PMA] 33 weeks, IQR: 31.7- 34.4 weeks) and term-equivalent age (TEA) (median PMA 41.1 weeks, IQR: 39.6- 43.3 weeks) brain MRIs were performed in a prospective multisite cohort of very preterm infants born < 32 weeks) gestation. Presence of CbH (T1, T2 and SWI) was assessed by a pediatric neuroradiologist. Total CBH volume was calculated based on the manual segmentation performed by two trained raters. Hypotension requiring treatment, presence of a PDA requiring treatment, and the SNAPII Score (quantifying illness severity in first 12 hours of life) together with other comorbidities were recorded. Uni- and multivariable regression analyses were conducted. Presence of CbH, presence vermis hemorrhage and CbH volume were outcomes variables. Results: 309 very preterm infants (27.6 ± 2 weeks) were included. 60 infants presented CbH (19.4%), vermis involvement was observed in 14 infants. Infants with CbH had lower GA and rate of C section, and higher rates of prolonged mechanical ventilation, NEC stage 2 or higher, coagulopathy, PDA, IVH and higher SNAP-II score (p < 0.05). On univariable regression, variables related to hemodynamic disturbances were associated with CbH, vermis involvement and CbH volume (p < 0.05). Multivariable regression showed that hypotension requiring inotropes was independently associated with the presence of CbH (OR 3.93, 95% CI 1.65 - 9.37, P = 0.002) and vermis involvement (OR 5.33, 95% CI 1.18 - 24.04, P = 0.029). Although hypotension requiring inotropes was also associated to CbH volume (0.36 log mm3 ,95% CI 0.17 - 0.54, p < 0.001), this model does not explain a large amount of variance in CbH volume.
Conclusion(s): This study highlights the important role that hemodynamic disturbances play in CbH with significant hypotension requiring treatment with inotropes being an independent risk factor for CbH. Factors associated to larger CbH volumes need further attention.
