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Volumetric analysis of the brainstem and cerebellum in premature and term infants

INTRODUCTION: Improved perinatal care has led to increased survival of premature infants. These children often have different motoric, cognitive and psychological disorders. Clinical manifestations of perinatal hypoxic-ischemic encephalopathy are largely considered a consequence of cerebral white matter lesions. Using magnetic resonance imaging (MRI) and advanced morphometric software it is possible to quantify the area and volume of different brain structures. Measurements of cerebellum and brainstem volumetric parameters in term and preterm children can advance our understanding of normal prenatal development as well as mechanisms of prenatal brain injury. METHODS: All volumes were measured on 3T MR images utilizing semi-automated (MNI toolbox) and manual segmentation methods (Analyze 8.1). The study included 10 normal term infants, 10 normotypic premature infants without lesions, and 10 premature infants who have lesions associated with perinatal hypoxic-ischemic encephalopathy. All groups were scanned by MRI device twice, first at the corrected term age and second at the age of two years. RESULTS: Among normal term infants average volume of cerebellum was 28, 84 ± 1, 58 cm3 and volume of brainstem was 6, 92 ± 1, 06 cm3. Average volume of cerebellum in normotypic premature infants without lesions was 22, 85 ± 1, 59 cm3 and volume of brainstem was 6, 08 ± 1, 22 cm3. Premature infants who have lesions associated with perinatal hypoxic-ischemic encephalopathy had average volume of cerebellum 21, 24 cm3 ± 1, 97 and volume of brainstem 5, 37 ± 1, 18 cm3. CONCLUSIONS: Volumetric analysis revealed significant difference between preterm and term children. It also displays inequality between preterm children with neurological and psychological disorders compared to preterm children without neurological symptoms. Normal growth of cerebellum and brainstem is essential for normal development of premature infants and early detection of growth disturbances increases the possibility of timely interventions in order to reduce subsequent neurological and psychological disorders.

brainstem ; MRI ; perinatal hypoxic-ischemic encephalopathy ; premature infant

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