Published online March 1, 2005
PEDIATRICS Vol. 115 No. 3 March 2005, pp. 688-695 (doi:10.1542/peds.2004-1169)
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Right arrow Premature & Newborn

Late Gestation Cerebellar Growth Is Rapid and Impeded by Premature Birth

Catherine Limperopoulos, PhD*, Janet S. Soul, MD*, Kimberlee Gauvreau, ScD{ddagger}, Petra S. Huppi, MD*, Simon K. Warfield, PhD§, Haim Bassan, MD*, Richard L. Robertson, MD||, Joseph J. Volpe, MD* and Adré J. du Plessis, MBChB, MPH*

* Neurology
{ddagger} Cardiology and Cardiovascular Surgery
|| Radiology, Children’s Hospital Boston and Harvard Medical School, Boston, Massachusetts
§ Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts

Objective. Cognitive impairments and academic failure are commonly reported in survivors of preterm birth. Recent studies suggest an important role for the cerebellum in the development of cognitive and social functions. The objective of this study was to examine the impact of prematurity itself, as well as prematurity-related brain injuries, on early postnatal cerebellar growth with quantitative MRI.

Methods. Advanced 3-dimensional volumetric MRI was performed and cerebellar volumes were obtained by manual outlining in preterm (<37 weeks) and healthy term-born infants. Intracranial and total brain volumes were also calculated.

Results. A total of 169 preterm and 20 healthy full-term infants were studied; 145 had preterm MRI (pMRI), 75 had term MRI (tMRI), and 51 underwent both pMRI and tMRI. From 28 weeks’ postconceptional age to term, mean cerebellar volume (177%) in preterm infants increased at a much faster rate than did mean intracranial (110%) or mean brain (107%) volumes. Smaller cerebellar volume was significantly related to lower gestational age at birth and to intracranial and total brain volumes. Mean cerebellar volume of preterm infants at tMRI was significantly smaller than the volumes of term-born infants. Cerebellar growth impairment was correlated strongly with associated brain injuries, even in the absence of direct cerebellar injury.

Conclusions. Our data suggest that the growth of the immature cerebellum is particularly rapid during late gestation. However, this accelerated growth seems to be impeded by premature birth and associated brain injury. The long-term neurodevelopmental disabilities seen in survivors of premature birth may be attributable in part to impaired cerebellar development.

Key Words: premature infants • magnetic resonance • cerebellum • brain injury • development

Abbreviations: PT, preterm • TB, term born • PDA, patent ductus arteriosis • pMRI, preterm MRI • tMRI, term MRI • 3D, 3-dimensional • SPGR, spoiled gradient recalled • CSF, cerebrospinal fluid • IVH, intraventricular hemorrhage

Accepted Jul 30, 2004.




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