Ultrasonically detectable cerebellar haemorrhage in preterm infants

Objective To determine the frequency and pattern of cerebellar haemorrhage (CBH) on routine cranial ultrasound (cUS) imaging in infants of <= 32 weeks gestation, and to investigate how extremely preterm infants with CBH differ from those with severe intraventricular haemorrhage (IVH). Methods 672 infants of <= 32 weeks gestation were prospectively examined for CBH on serial cUS imaging. In a separate case-control analysis, the clinical features, ultrasound findings and outcome of preterm infants with CBH were compared to those of infants with isolated severe IVH (grade III-IV). Results Nine cases of CBH were identified among 53 infants with severe IVH. The incidence of CBH in infants of <= 32 weeks gestation was 1.3%. Five infants had bilateral CBH involving both hemispheres, three had unilateral left sided CBH and one had a right hemispheric lesion. Infants with CBH were male, significantly more preterm (24.4 vs 27.0 weeks) and of lower birth weight (692 g vs 979 g). Vaginal births predominated in the CBH group (89% vs 50%). The median time to identification of haemorrhage for both groups was 3 days. Mortality in the CBH group was 100% (9/9) compared to 43% (19/44) in the severe IVH group. Conclusions Extensive CBH in preterm infants is rare and devastating. It appears to be confined to very preterm, extremely low birthweight infants and may have a male predominance. The co-existence of severe IVH and extensive CBH on routine cot-side cUS in the early neonatal period is an ominous finding.