TY - JOUR
T1 - Cerebellar Hemorrhage in Preterm Infants
T2 - A Meta-Analysis on Risk Factors and Neurodevelopmental Outcome
AU - Villamor, Eduardo
AU - Fumagalli, Monica
AU - Alomar, Yaser Ibrahim
AU - Passera, Sofia
AU - Cavallaro, Giacomo
AU - Mosca, Fabio
AU - Villamor, Eduardo
N1 - Publisher Copyright:
© 2019 Villamor-Martinez, Fumagalli, Alomar, Passera, Cavallaro, Mosca and Villamor.
PY - 2019/6/25
Y1 - 2019/6/25
N2 - 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 -173g, 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.
AB - 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 -173g, 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.
KW - cerebellar hemorrhage
KW - prematurity
KW - meta-analysis
KW - systematic review
KW - risk factors
KW - neurodevelopmental outcome
KW - cerebral palsy
KW - ANTENATAL CORTICOSTEROIDS
KW - GERMINAL MATRIX
KW - BRAIN
KW - INJURY
KW - BIRTH
KW - GROWTH
KW - CHORIOAMNIONITIS
KW - PREVALENCE
KW - ULTRASOUND
KW - INFECTION
U2 - 10.3389/fphys.2019.00800
DO - 10.3389/fphys.2019.00800
M3 - (Systematic) Review article
C2 - 31293454
SN - 1664-042X
VL - 10
SP - 1
EP - 11
JO - Frontiers in physiology
JF - Frontiers in physiology
M1 - 800
ER -