Cerebellar hemorrhage in preterm infants

A meta-analysis on risk factors and neurodevelopmental outcome

Eduardo Villamor-Martinez, Monica Fumagalli, Yaser Ibrahim Alomar, Sofia Passera, Giacomo Cavallaro, Fabio Mosca, Eduardo Villamor

Research output: Contribution to journalReview article

Abstract

Cerebellar hemorrhage (CBH) represents the most commonly acquired lesion of the posterior fossa in the neonatal period. We aimed to perform a systematic review and meta-analysis of studies exploring the perinatal risk factors and neurological outcome of CBH in preterm infants. A comprehensive literature search was conducted using PubMed/MEDLINE and EMBASE. Studies were included if they examined preterm infants and reported primary data on maternal, obstetric, or perinatal characteristics, and/or outcomes of infants with and without CBH. A random-effects model was used to calculate mean differences (MD), odds ratios (OR), and 95% confidence intervals (CI). We found 231 potentially relevant studies, of which 15 met the inclusion criteria (4,236 infants, 347 CBH cases). Meta-analysis could not demonstrate a significant association between CBH and multiple gestation, chorioamnionitis, pre-eclampsia, placental abruption, use of antenatal corticosteroids, mode of delivery, or infant sex. Infants with CBH had a significantly lower gestational age (6 studies, MD-1.55 weeks, 95% CI-1.93 to-1.16) and birth weight (6 studies, MD-173 g, 95% CI-225 to-120), and significantly higher rates of intubation at birth, hypotension, patent ductus arteriosus, intraventricular hemorrhage, sepsis, necrotizing enterocolitis, and bronchopulmonary dysplasia. CBH was significantly associated with delayed mental (6 studies, OR 2.95, 95% CI 1.21 to 7.20) and psychomotor (6 studies, OR 3.62, 95% CI 1.34 to 9.76) development, and higher rates of cerebral palsy (4 studies, OR 3.09, 95% CI 1.55 to 6.19). In conclusion, the present meta-analysis shows that the youngest and sickest preterm infants are at higher risk of developing CBH. Our results highlight the multifactorial nature of CBH and reinforce the idea that cerebellar injury in very preterm newborns has important neurodevelopmental consequences among survivors.

Original languageEnglish
Article number800
JournalFrontiers in Physiology
Volume10
Issue numberJUN
DOIs
Publication statusPublished - Jan 1 2019

Fingerprint

Premature Infants
Meta-Analysis
Hemorrhage
Confidence Intervals
Odds Ratio
Abruptio Placentae
Chorioamnionitis
Bronchopulmonary Dysplasia
Necrotizing Enterocolitis
Patent Ductus Arteriosus
Cerebral Palsy
Pre-Eclampsia
PubMed
Intubation
Birth Weight
MEDLINE
Hypotension
Gestational Age
Obstetrics
Sepsis

Keywords

  • Cerebellar hemorrhage
  • Cerebral palsy
  • Meta-analysis
  • Neurodevelopmental outcome
  • Prematurity
  • Risk factors
  • Systematic review

ASJC Scopus subject areas

  • Physiology
  • Physiology (medical)

Cite this

Cerebellar hemorrhage in preterm infants : A meta-analysis on risk factors and neurodevelopmental outcome. / Villamor-Martinez, Eduardo; Fumagalli, Monica; Alomar, Yaser Ibrahim; Passera, Sofia; Cavallaro, Giacomo; Mosca, Fabio; Villamor, Eduardo.

In: Frontiers in Physiology, Vol. 10, No. JUN, 800, 01.01.2019.

Research output: Contribution to journalReview article

Villamor-Martinez, Eduardo ; Fumagalli, Monica ; Alomar, Yaser Ibrahim ; Passera, Sofia ; Cavallaro, Giacomo ; Mosca, Fabio ; Villamor, Eduardo. / Cerebellar hemorrhage in preterm infants : A meta-analysis on risk factors and neurodevelopmental outcome. In: Frontiers in Physiology. 2019 ; Vol. 10, No. JUN.
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abstract = "Cerebellar hemorrhage (CBH) represents the most commonly acquired lesion of the posterior fossa in the neonatal period. We aimed to perform a systematic review and meta-analysis of studies exploring the perinatal risk factors and neurological outcome of CBH in preterm infants. A comprehensive literature search was conducted using PubMed/MEDLINE and EMBASE. Studies were included if they examined preterm infants and reported primary data on maternal, obstetric, or perinatal characteristics, and/or outcomes of infants with and without CBH. A random-effects model was used to calculate mean differences (MD), odds ratios (OR), and 95{\%} confidence intervals (CI). We found 231 potentially relevant studies, of which 15 met the inclusion criteria (4,236 infants, 347 CBH cases). Meta-analysis could not demonstrate a significant association between CBH and multiple gestation, chorioamnionitis, pre-eclampsia, placental abruption, use of antenatal corticosteroids, mode of delivery, or infant sex. Infants with CBH had a significantly lower gestational age (6 studies, MD-1.55 weeks, 95{\%} CI-1.93 to-1.16) and birth weight (6 studies, MD-173 g, 95{\%} CI-225 to-120), and significantly higher rates of intubation at birth, hypotension, patent ductus arteriosus, intraventricular hemorrhage, sepsis, necrotizing enterocolitis, and bronchopulmonary dysplasia. CBH was significantly associated with delayed mental (6 studies, OR 2.95, 95{\%} CI 1.21 to 7.20) and psychomotor (6 studies, OR 3.62, 95{\%} CI 1.34 to 9.76) development, and higher rates of cerebral palsy (4 studies, OR 3.09, 95{\%} CI 1.55 to 6.19). In conclusion, the present meta-analysis shows that the youngest and sickest preterm infants are at higher risk of developing CBH. Our results highlight the multifactorial nature of CBH and reinforce the idea that cerebellar injury in very preterm newborns has important neurodevelopmental consequences among survivors.",
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