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. 2019 Jun 25:10:800.
doi: 10.3389/fphys.2019.00800. eCollection 2019.

Cerebellar Hemorrhage in Preterm Infants: A Meta-Analysis on Risk Factors and Neurodevelopmental Outcome

Eduardo Villamor-Martinez  1 , Monica Fumagalli  2   3 , Yaser Ibrahim Alomar  1 , Sofia Passera  2 , Giacomo Cavallaro  2 , Fabio Mosca  2   3 , Eduardo Villamor  1
Affiliations

Cerebellar Hemorrhage in Preterm Infants: A Meta-Analysis on Risk Factors and Neurodevelopmental Outcome

Eduardo Villamor-Martinez et al. Front Physiol. .

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.

Keywords: cerebellar hemorrhage; cerebral palsy; meta-analysis; neurodevelopmental outcome; prematurity; risk factors; systematic review.

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Figures

Figure 1
Figure 1
PRISMA flow diagram of the systematic search.
Figure 2
Figure 2
Meta-analysis of mean difference in gestational age, comparing cerebellar hemorrhage (CBH)-group and control group.
Figure 3
Figure 3
Meta-analysis of mean difference in birth weight, comparing cerebellar hemorrhage (CBH)-group and control group.
Figure 4
Figure 4
Meta-analysis of the association between cerebellar hemorrhage (CBH) and maternal, obstetric and perinatal characteristics, and short-term neonatal outcomes. PDA, patent ductus arteriosus; NEC, necrotizing enterocolitis; BPD, bronchopulmonary dysplasia; IVH, intraventricular hemorrhage.
Figure 5
Figure 5
Meta-analysis of the association between cerebellar hemorrhage (CBH) and risk of delayed mental development. CI, confidence interval.
Figure 6
Figure 6
Meta-analysis of the association between cerebellar hemorrhage (CBH) and risk of delayed psychomotor development. CI, confidence interval.
Figure 7
Figure 7
Meta-analysis of the association between cerebellar hemorrhage (CBH) and risk of cerebral palsy (CP). CI, confidence interval.
See this image and copyright information in PMC

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