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

Pediatric Research volume 92, pages 225–232 (2022)Cite this article

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

Impact

  • 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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Acknowledgements

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

Author information

Author notes

  1. These authors contributed equally: Astrid Nieuwets, Mehmet N. Cizmeci.

Authors and Affiliations

  1. Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, and Utrecht University, Utrecht, The Netherlands

    Astrid Nieuwets, Mehmet N. Cizmeci, Floris Groenendaal, Lara M. Leijser, Corine Koopman, Manon J. N. L. Benders, Jeroen Dudink, Linda S. de Vries & Niek E. van der Aa

  2. Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands

    Astrid Nieuwets, Mehmet N. Cizmeci, Floris Groenendaal, Lara M. Leijser, Corine Koopman, Manon J. N. L. Benders, Jeroen Dudink, Linda S. de Vries & Niek E. van der Aa

  3. Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Mehmet N. Cizmeci

  4. Section of Neonatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Lara M. Leijser

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Contributions

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.

Corresponding author

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). https://doi.org/10.1038/s41390-021-01704-2

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