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Small Cerebellar Hemorrhage in Preterm Infants: Perinatal and Postnatal Factors and Outcome

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Abstract

The objective of the study is to determine perinatal and postnatal factors that may affect the occurrence of small cerebellar hemorrhage (CBH) and to evaluate the effect of small CBH on neurodevelopmental outcome in very preterm infants. This prospective study in an unselected cohort of very preterm infants was approved by the medical ethics committee, and informed parental consent was obtained. Presence of small CBH (<4 mm) was assessed with magnetic resonance imaging around term equivalent age in 108 preterm infants (<32 weeks gestation). We compared infants with and without small CBH for perinatal and postnatal factors, supratentorial brain injury, and for neurodevelopmental outcome at 2 years corrected age. Follow-up consisted of a neurological examination, mental and developmental assessment (Bayley Scales of Infant Development), and behavior checklist. Univariate and multivariate logistic regression analyses were performed to examine the relationships between variables. Small CBH was diagnosed in 16/108 very preterm infants. Univariate analyses identified gestational age, high-frequency oscillation (HFO) ventilation, and grade 3–4 intraventricular hemorrhage (IVH) as factors associated with small CBH. HFO ventilation and severe IVH were independent predictors of small CBH. We found no association between small CBH and neurodevelopmental outcome at 2 years of age. Small CBH is a frequent finding in preterm infants. These hemorrhages are independently associated with HFO ventilation and severe supratentorial hemorrhage and seem to have a favorable short-term prognosis.

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Acknowledgments

We thank A. van Steenis and A. Jansen for collecting the perinatal data.

Funding Source

Financial activities related to the present article: Lara M. Leijser received a grant (no 920-03-388) from ZonMw, The Netherlands Organization for Health Research and Development.

Financial Disclosure Statement

The authors have no financial relationships to disclose which are relevant to this article.

Conflicts of Interest Statement

The authors have no conflicts of interest to disclose.

Clinical Trial Registry

This study was part of a research project on brain injury in very preterm infants registered in the Dutch trial register: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=676.

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Author notes

  1. Gerda van Wezel-Meijler

    Present address: Department of Neonatology, Isala Hospitals, Zwolle, The Netherlands

Authors and Affiliations

  1. Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands

    Sylke J. Steggerda, Monique Rijken, Lara M. Leijser, Frans J. Walther & Gerda van Wezel-Meijler

  2. Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands

    Francisca T. De Bruïne & Annette A. van den Berg-Huysmans

Authors
  1. Sylke J. Steggerda
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  2. Francisca T. De Bruïne
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  3. Annette A. van den Berg-Huysmans
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  4. Monique Rijken
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  5. Lara M. Leijser
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  6. Frans J. Walther
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  7. Gerda van Wezel-Meijler
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Correspondence to Sylke J. Steggerda.

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Steggerda, S.J., De Bruïne, F.T., van den Berg-Huysmans, A.A. et al. Small Cerebellar Hemorrhage in Preterm Infants: Perinatal and Postnatal Factors and Outcome. Cerebellum 12, 794–801 (2013). https://doi.org/10.1007/s12311-013-0487-6

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  • DOI: https://doi.org/10.1007/s12311-013-0487-6

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