Location and size of preterm cerebellar hemorrhage and childhood development

OBJECTIVES To examine the association between cerebellar hemorrhage (CBH) size and location and preschool-age neurodevelopment in very preterm neonates. METHODS Preterm MRIs of 221 very preterm neonates (median GA 27.9) were manually segmented for CBH quantification and location. Neurodevelopmental assessments at chronological age 4.5 years included motor (MABC-2), visuomotor integration (Beery VMI-6), cognitive (WPPSI-III), and behavioral (CBCL) outcomes. Multivariable linear regression models examined the association between CBH size and 4.5-year outcomes accounting for sex, gestational age, and supratentorial injury. Probabilistic maps assessed CBH location and likelihood of a lesion to predict adverse outcome. RESULTS Thirty-six neonates had CBH: 14 (6%) with only punctate CBH and 22 (10%) with ≥1 larger CBH. CBH occurred mostly in the inferior aspect of the posterior lobes. CBH total volume was independently associated with MABC-2 motor scores at 4.5 years (β=-0.095, 95% CI [-0.184, -0.005]) with a standardized β coefficient (-0.16) that was similar to that of white matter injury volume (standardized β=-0.22). CBH size was similarly associated with visuomotor integration and externalizing behavior but not cognition. Voxel-wise odds ratio and lesion-symptom maps demonstrated that CBH extending more deeply into the cerebellum predicted adverse motor, visuomotor, and behavioral outcomes. INTERPRETATION CBH size and location on preterm MRI were associated with reduced preschool motor and visuomotor function and more externalizing behavior independent of supratentorial brain injury in a dose-dependent fashion. The volumetric quantification and localisation of CBH, even when punctate, may allow opportunity to improve motor and behavioral outcomes by providing targeted intervention. This article is protected by copyright. All rights reserved.