Impaired trophic interactions between the cerebellum and the cerebrum among preterm infants.
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.


OBJECTIVE
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.
Limperopoulos
Catherine
C
Department of Neurology, Children's Hospital, Boston, MA 02115, USA.
Soul
Janet S
JS
Haidar
Haissam
H
Huppi
Petra S
PS
Bassan
Haim
H
Warfield
Simon K
SK
Robertson
Richard L
RL
Moore
Marianne
M
Akins
Patricia
P
Volpe
Joseph J
JJ
du Plessis
Adré J
AJ
D002531:Cerebellum / Q000473:pathology*; D002543:Cerebral Hemorrhage / Q000473:pathology; D002544:Cerebral Infarction / Q000473:pathology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000473:pathology*; D007969:Leukomalacia, Periventricular / Q000473:pathology; D008279:Magnetic Resonance Imaging