Effects of intraventricular hemorrhage on white matter microstructural changes at term and early developmental outcomes in infants born very preterm

Weihong Yuan, Leanne Tamm, Karen Harpster, Mekibib Altaye, Venkata Sita Priyanka Illapani, Nehal A Parikh, Weihong Yuan, Leanne Tamm, Karen Harpster, Mekibib Altaye, Venkata Sita Priyanka Illapani, Nehal A Parikh

Abstract

Purpose: Very preterm (VPT) infants are at high risk for motor and behavioral deficits. We investigated microstructural differences using diffusion tensor imaging (DTI) among VPT infants with different grades of intraventricular hemorrhage (IVH), their association with early motor function and temperament ratings, and the potential moderating effect of IVH severity on the above structure-function relations.

Methods: Fifty-seven VPT (≤32 weeks gestational age) infants with IVH (Low Grade (Papile grading I/II): 42; High Grade (III/IV): 15) were studied. DTI was acquired between 39 and 44 weeks postmenstrual age and was analyzed using the tract-based spatial statistics approach. Early motor function and temperament were assessed at 3-month corrected age based on the Hammersmith Infant Neurological Examination (HINE) and Infant Behavioral Questionnaire - Revised, Short Version (IBQ-R-S), respectively.

Results: Significantly lower fractional anisotropy and higher mean, axial, and/or radial diffusivity were found in VPT infants with High Grade IVH compared to Low Grade IVH (p < 0.05). Significant associations were found between DTI metrics and motor function in both IVH groups and between DTI and Fear temperament ratings in the High Grade IVH Group (all p < 0.05). IVH severity had a significant moderating effect on the relation between DTI and motor and Fear ratings (p < 0.05).

Conclusion: DTI is a sensitive neuroimaging biomarker providing a refined understanding of the impact and location of differing severities of IVH on the developing white matter of VPT infants. Early motor and behavioral outcomes are associated with microstructural changes that are influenced by severity of IVH.

Keywords: DTI; Intraventricular hemorrhage severity; Motor; Temperament; Very preterm.

Conflict of interest statement

Conflict of interest - The authors declare that they have no conflict of interest.

Competing Financial Interests

The authors declare no competing interests.

© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Figures

Figure 1.
Figure 1.
White matter areas with significant group difference in DTI (pLow Grade > FAHigh Grade; (B) MDLow Grade < MDHigh Grade; (C) ADLow Grade < ADHigh Grade; and (D) RDLow Grade < RDHigh Grade.
Figure 2.
Figure 2.
White matter areas in patients with significant correlation between DTI at term and HINE score at 3 months corrected age (p

Figure 3.

White matter areas with significant…

Figure 3.

White matter areas with significant correlation between DTI at term age and temperament…

Figure 3.
White matter areas with significant correlation between DTI at term age and temperament ratings of Fear at 3 months corrected age (p

Figure 4.

(A) White matter regions with…

Figure 4.

(A) White matter regions with significant interaction effect of IVH severity on the…

Figure 4.
(A) White matter regions with significant interaction effect of IVH severity on the association between MD and HINE at 3 months corrected age. (B) Post-hoc comparison of the association between DTI and outcomes in the two study groups within the area with significant interaction of IVH severity on the association between MD and HINE

Figure 5.

White matter regions with significant…

Figure 5.

White matter regions with significant interaction effect of IVH severity on the association…

Figure 5.
White matter regions with significant interaction effect of IVH severity on the association between FA and Fear score (A), between MD and Fear score (C) and between AD and Fear score (E). Post-hoc comparison of the association between DTI and outcomes in the two study groups within the area with significant interaction of IVH severity on the association between FA and Fear (B), between MD and Fear (D) and between AD and Fear (F).
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References
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Figure 3.
Figure 3.
White matter areas with significant correlation between DTI at term age and temperament ratings of Fear at 3 months corrected age (p

Figure 4.

(A) White matter regions with…

Figure 4.

(A) White matter regions with significant interaction effect of IVH severity on the…

Figure 4.
(A) White matter regions with significant interaction effect of IVH severity on the association between MD and HINE at 3 months corrected age. (B) Post-hoc comparison of the association between DTI and outcomes in the two study groups within the area with significant interaction of IVH severity on the association between MD and HINE

Figure 5.

White matter regions with significant…

Figure 5.

White matter regions with significant interaction effect of IVH severity on the association…

Figure 5.
White matter regions with significant interaction effect of IVH severity on the association between FA and Fear score (A), between MD and Fear score (C) and between AD and Fear score (E). Post-hoc comparison of the association between DTI and outcomes in the two study groups within the area with significant interaction of IVH severity on the association between FA and Fear (B), between MD and Fear (D) and between AD and Fear (F).
Figure 4.
Figure 4.
(A) White matter regions with significant interaction effect of IVH severity on the association between MD and HINE at 3 months corrected age. (B) Post-hoc comparison of the association between DTI and outcomes in the two study groups within the area with significant interaction of IVH severity on the association between MD and HINE
Figure 5.
Figure 5.
White matter regions with significant interaction effect of IVH severity on the association between FA and Fear score (A), between MD and Fear score (C) and between AD and Fear score (E). Post-hoc comparison of the association between DTI and outcomes in the two study groups within the area with significant interaction of IVH severity on the association between FA and Fear (B), between MD and Fear (D) and between AD and Fear (F).

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