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Post-hemorrhagic ventricular dilatation affects white matter maturation in extremely preterm infants



Data on microstructural white matter integrity in preterm infants with post-hemorrhagic ventricular dilatation (PHVD) using diffusion tensor imaging (DTI) are limited. Also, to date, no study has focused on the DTI changes in extremely preterm (EP) infants with PHVD.


A case–control study of EP infants <28 weeks’ gestation with PHVD was conducted. Diffusivity and fractional anisotropy (FA) values of corticospinal tracts (CST) and corpus callosum (CC) were measured using DTI at term-equivalent age. Outcomes were assessed at 2-years-corrected age.


Twenty-one infants with PHVD and 21 matched-controls were assessed. FA values in the CC were lower in infants with PHVD compared with controls (mean difference, 0.05 [95% confidence interval (CI), 0.02–0.08], p < 0.001). In infants with periventricular hemorrhagic infarction, FA values in the CC were lower than in controls (mean difference, 0.05 [95% CI, 0.02–0.09], p = 0.005). The composite cognitive and motor scores were associated with the FA value of the CC (coefficient 114, p = 0.01 and coefficient 147, p = 0.004; respectively).


Extremely preterm infants with PHVD showed lower FA values in CC. A positive correlation was also shown between the composite cognitive and motor scores and FA value of the CC at 2-years-corrected age.


  • Extremely preterm infants with post-hemorrhagic ventricular dilatation showed lower fractional anisotropy values in their corpus callosum compared with controls reflecting the impaired microstructure of these commissural nerve fibers that are adjacent to the dilated ventricles.

  • Impaired microstructure of the corpus callosum was shown to be associated with cognitive and motor scores at 2-years-corrected age.

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Fig. 1: Association between the corpus callosum FA and cognitive scores.


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We thank the neonatal intensive care physicians, nurses, and physician assistants as well as developmental specialists and MR technicians for their dedicated help.

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Authors and Affiliations



A.N. conceptualized and designed the study, acquired the data including the chart review, and conducted the technical analysis of the brain MR images. She revised the article and approved the final version for publication. M.N.C. acquired the data, conducted the statistical analysis, wrote the first draft and revised version of the manuscript, and contacted the co-authors for further revisions. He approved the final version for publication. F.G. conducted the statistical analysis, critically reviewed, and approved the final version of the manuscript for publication. L.M.L. helped conceptualize and design the study, critically reviewed, and approved the final version of the manuscript for publication. C.K. helped to acquire the data, critically reviewed, and approved the final version of the manuscript for publication. M.J.N.L.B. helped acquiring the data, critically reviewed and approved the final version of the manuscript for publication. J.D. helped acquiring the data, critically reviewed and approved the final version of the manuscript for publication. L.S.d.V. conceptualized and designed the study, helped to draft the manuscript, and revising it for intellectual content. She approved the final version for publication. N.E.v.d.A. contributed significantly to the data acquisition by reviewing the brain imaging. He also helped to conceptualize the study and revising the manuscript for intellectual content. He approved the final version for publication.

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Correspondence to Niek E. van der Aa.

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Nieuwets, A., Cizmeci, M.N., Groenendaal, F. et al. Post-hemorrhagic ventricular dilatation affects white matter maturation in extremely preterm infants. Pediatr Res 92, 225–232 (2022).

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