Elsevier

The Journal of Pediatrics

Volume 158, Issue 2, February 2011, Pages 245-250
The Journal of Pediatrics

Original Article
Cerebellar Hemorrhage on Magnetic Resonance Imaging in Preterm Newborns Associated with Abnormal Neurologic Outcome

https://doi.org/10.1016/j.jpeds.2010.07.049Get rights and content

Objective

To investigate the relationship between cerebellar hemorrhage in preterm infants seen on magnetic resonance imaging (MRI), but not on ultrasonography, and neurodevelopmental outcome.

Study design

Images from a cohort study of MRI in preterm newborns were reviewed for cerebellar hemorrhage. The children were assessed at a mean age of 4.8 years with neurologic examination and developmental testing using the Wechsler Preschool and Primary Scale of Intelligence, Third Edition.

Results

Cerebellar hemorrhage was detected on both ultrasonography and MRI in 3 of the 131 preterm newborns evaluated, whereas smaller hemorrhages were seen only on MRI in 10 newborns (total incidence, 10%). Adjusting for gestational age at birth, intraventricular hemorrhage, and white matter injury, cerebellar hemorrhage detectable solely by MRI was associated with a 5-fold increased odds of abnormal neurologic examination compared with newborns without cerebellar hemorrhage (outcome data in 74%). No association with the Wechsler Preschool and Primary Scale of Intelligence, Third Edition score was found.

Conclusions

Cerebellar hemorrhage is not uncommon in preterm newborns. Although associated with neurologic abnormalities, hemorrhage seen only on MRI is associated with much more optimistic outcomes than that visible on ultrasonography.

Section snippets

Methods

Preterm newborns admitted to the intensive care nursery at the University of California San Francisco (UCSF) were recruited from 1998 to 2003 as part of an ongoing prospective cohort study of brain injury and development using sequential MRI scans. Inborn and outborn neonates born at <34 weeks gestational age were eligible for the study. Exclusion criteria for study enrollment were: (1) clinical evidence of a congenital malformation or syndrome; (2) congenital TORCH infection; and (3)

Results

A cohort of 131 preterm newborns was enrolled, all of which underwent both cranial ultrasound and MRI scans during their hospital stay. Cerebellar hemorrhage was seen on cranial ultrasound in 3 newborns. All 3 of these hemorrhages were confirmed on MRI, and an additional 10 cerebellar hemorrhages that were not detected by ultrasound were seen on MRI. Three newborns died during admission in the nursery, two of whom had ultrasound-detected cerebellar hemorrhage. Of the 128 survivors, 94 underwent

Discussion

Although large cerebellar hemorrhage carries a high risk of mortality and severe neurodevelopmental deficits,8 the effects of smaller cerebellar hemorrhages seen on MRI but not on cranial ultrasound have not been reported previously. The results of the present prospective cohort study suggest that smaller cerebellar hemorrhages seen only on MRI are associated with an increased risk for abnormalities on neurologic examination, but that the presence of these hemorrhages is not associated with

References (19)

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Supported by the National Institutes of Health (NIH; Grant R01 NS346432, Grant UL1 RR024131, and Grant KL2 RR024130 to H.G.). E.T. is a Cerebral Palsy International Research Foundation Ethel & Jack Hausman Clinical Research Scholar. The authors declare no conflicts of interest.

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