Published online September 30, 2005
PEDIATRICS Vol. 116 No. 4 October 2005, pp. 844-850 (doi:10.1542/peds.2004-2282)

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Impaired Trophic Interactions Between the Cerebellum and the Cerebrum Among Preterm Infants

Catherine Limperopoulos, PhD^*,, Janet S. Soul, MD^*,, Haissam Haidar, PhD^*,, Petra S. Huppi, MD, Haim Bassan, MD^*, Simon K. Warfield, PhD^,||, Richard L. Robertson, MD^¶, Marianne Moore, RN^*, Patricia Akins, BA^*, Joseph J. Volpe, MD^* and Adré J. du Plessis, MBChB, MPH^*

^* Departments of Neurology
^¶ Departments of Radiology, Children’s Hospital Boston
Departments of Surgical Planning Laboratory
Departments of Neonatology
^|| Departments of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts

Background. Advanced neuroimaging techniques have brought increasing recognition of cerebellar injury among premature infants. The developmental relationship between early brain injury and effects on the cerebrum and cerebellum remains unclear.

Objectives. To examine whether cerebral parenchymal brain lesions among preterm infants are associated with subsequent decreases in cerebellar volume and, conversely, whether primary cerebellar injury is associated with decreased cerebral brain volumes, with advanced, 3-dimensional, volumetric MRI at term gestational age equivalent.

Methods. Total cerebellar volumes and cerebellar gray and myelinated white matter volumes were determined through manual outlining for 74 preterm infants with unilateral periventricular hemorrhagic infarction (14 infants), bilateral diffuse periventricular leukomalacia (20 infants), cerebellar hemorrhage (10 infants), or normal term gestational age equivalent MRI findings (30 infants). Total brain and right/left cerebral and cerebellar hemispheric volumes were calculated.

Results. Unilateral cerebral brain injury was associated with significantly decreased volume of the contralateral cerebellar hemisphere. Conversely, unilateral primary cerebellar injury was associated with a contralateral decrease in supratentorial brain volume. Cerebellar gray matter and myelinated white matter volumes were reduced significantly not only among preterm infants with primary cerebellar hemorrhage but also among infants with cerebral parenchymal brain injury.

Conclusions. These data suggest strongly that both reduction in contralateral cerebellar volume with unilateral cerebral parenchymal injury and reduction in total cerebellar volume with bilateral cerebral lesions are related to trophic transsynaptic effects. Early-life cerebellar injury may contribute importantly to the high rates of cognitive, behavioral, and motor deficits reported for premature infants.

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Key Words: preterm infants • magnetic resonance imaging • brain injury • cerebellum • developmental

Abbreviations: PVL, periventricular leukomalacia • dPVL, diffuse periventricular leukomalacia • PVHI, periventricular hemorrhagic infarction • CBH, cerebellar hemorrhage • GAE, gestational age equivalent • CSF, cerebrospinal fluid • SPGR, spoiled gradient recalled

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Accepted Jan 13, 2005.

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