Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Master of Science

Program

Neuroscience

Supervisor

de Ribaupierre, Sandrine

2nd Supervisor

Duerden, Emma G

Co-Supervisor

Abstract

Germinal Matrix-Intraventricular hemorrhage (GMH-IVH) remains a significant cause of adverse neurodevelopmental outcomes in preterm infants. Current management options for GMH-IVH rely on serial 2-dimensional cranial ultrasound (2D cUS) ventricular measurements and clinical signs. A need exists for reliable biomarkers to aid in the early detection of posthemorrhagic ventricular dilatation (PHVD) and cerebral palsy (CP). We incorporated 3-dimensional cranial US (3D cUS) and functional infrared spectroscopy (fNIRS) to monitor ventricle volumes (VV) and spontaneous functional connectivity (sFC) in preterm infants with GMH-IVH. Infants with severe GMH-IVH who underwent cerebrospinal fluid diversion showed larger VV, which correlated with decreased sFC. Our findings of increased ventricular volume in preterm neonates and reduced fNIRS-based functional connectivity suggest that regional disruptions of ventricular size may impact the development of the underlying grey matter. Findings suggest that 3D cUS and fNIRS are promising bedside tools for monitoring the progression of GMH-IVH in preterm infants.

Summary for Lay Audience

Despite improved care, infants born early still face complications related to being born prematurely. One of these complications is germinal matrix-intraventricular hemorrhage (GMH-IVH) or bleeding into the infant’s lateral ventricles of the brain (a space in the brain prone to bleeding). The blood can block the reabsorption of fluid within the ventricles, called cerebrospinal fluid (CSF), which can lead to enlargement of the ventricles. Among infants born early, some key adverse long-term outcomes of GMH-IVH include difficulties with movement (cerebral palsy) and learning. This means that children with GMH-IVH may be more likely to experience early diversity at school-going age than children without. Once born, during their admission to the neonatal intensive care unit (NICU), these preterm infants undergo screening for GMH-IVH. Clinicians rely on 2-dimensional cranial ultrasound (2D cUS) to measure the size and shape of the ventricles and clinical signs. However, these tools are inadequate. A gap exists for more reliable tools to aid in the early detection of ventricular dilatation after GMH-IVH to allow for early intervention. Our study used a combination of bedside tools: three-dimensional cranial US (3D cUS) - to monitor the ventricle volumes (VV); and functional infrared spectroscopy (fNIRS) - to monitor oxygen delivery to the brain. We found that increased ventricle volumes and impaired oxygen delivery to the infant's brain among infants with GMH-IVH suggest impairment to the growing brain. Our findings suggest that 3D cUS and fNIRS are promising bedside tools for monitoring the progression of GMH-IVH in preterm infants. These bedside tools provide additional information regarding the structure and function of the preterm infant's brain.

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