0:01

So, uh, preterm brain injuring, um, imaging.

0:03

Uh, so they're gonna have an immature brain, right?

0:07

So less ated, less myelinated than a term, uh, infant.

0:11

Um, there's certain characteristic patterns we see

0:13

with preterm brain, the white matter injury, right?

0:16

Because the white matter is still, uh, developing.

0:18

You can have punctate lesions, punctate white mi lesions.

0:21

You can have diffuse, um, excessive, uh,

0:24

T two hyperintense signal, just like all the white matters.

0:26

Kinda a little bit of dus.

0:27

Uh, you can have the so-called paraventricular Leia

0:30

where you actually get cystic degeneration, um,

0:32

in these watershed areas

0:33

around the medullary veins that are draining.

0:37

Um, intraventricular hemorrhage.

0:38

So this is the pape, you know,

0:39

classic ultrasound classification.

0:41

And what I wanted to point out about the IVH grading one

0:44

to four is that it's actually a progression, right?

0:46

So you have the, the, uh, germinal matrix, the, um,

0:50

gives rise, it matures and migrates, right?

0:52

And forms your, uh, neuroglial structures.

0:54

But, uh, it involutes, uh, and migrates

0:57

and involutes by like 35 weeks, right?

1:00

So basically the last place

1:02

that it involutes at is the co thalamic groove.

1:04

And so in a mild preterm birth, right, that's

1:07

what you might just see the grade one

1:08

hemorrhage in the coth thalamic groove.

1:10

Um, grade two is when you actually have

1:12

intraventricular hemorrhage.

1:13

It could be some layering blood products.

1:14

There could just be some AP penal, uh, hemosiderin staining.

1:18

The, uh, the lining if it's already resorbed.

1:21

Uh, grade three is when you have ventricular magaly, right?

1:23

So now you're actually clogging some of the outflow tracks,

1:26

so you're actually getting some hydrocephalus.

1:28

And then grade four, um,

1:29

they talk about parenchymal involvement,

1:31

but it's not just any paral involvement.

1:33

'cause some of that could be white matter injury.

1:34

If it's distal, it's the idea that the, the clot is actually

1:38

occluding, the medullary venous drainage enough

1:41

that you're getting a medullary venous arm infarct

1:43

around the per ventricular white matter.

1:45

So it's a direct result of having clot,

1:47

like clogging the drainage pathway.

1:49

So it's actually a progression.

1:50

I'll show you examples of that.

1:53

And then cerebellar hemorrhage often under-recognized.

1:55

But, uh, really important

1:56

because preterm birth really has a lot

1:58

of long-term cognitive effects.

1:59

And we've come to understand in, in last, uh, decade

2:03

or so, that the cerebellum is not just

2:05

responsible for balance, right?

2:06

There's a lot of like a higher level

2:08

of cognitive executive function.

2:10

And so that, that relates again, to

2:12

that kinda long-term neurocognitive

2:14

effects of preterm birth.

2:15

And so there are, uh, infra tutorial, uh,

2:18

external granule cells, which are kind of the analogs

2:20

of the germinal matrix that are migrating at,

2:22

and those are also susceptible to injury.

2:25

Okay? So timing, people do not recommend MR for early,

2:28

you know, preterm birth

2:29

because like, you know, it's gonna be abnormal

2:31

or it's gonna have some of these findings.

2:33

So ultrasound for screening is fine.

2:35

And then if you see something, uh, you know,

2:37

fluidly abnormal, you can get an MR to confirm.

2:40

But again, that just kind of tells you about etiology.

2:41

You know, it's gonna be abnormal if they're premature, uh,

2:45

the term equivalent, you know?

2:46

So basically once they're corrected, age is like 40 weeks,

2:49

like before they're about

2:50

to be discharged and they're stable.

2:51

That's been much more successful in the literature

2:54

for predicting long-term outcome

2:55

because you're looking at the complications

2:57

of the original insult and it's better for prognostication.

3:00

So, and they're gonna be more stable for mentioning as well.

3:02

So if you had to choose on generally speaking, it's better

3:05

to do term equivalent.

3:06

Uh, you can do early,

3:08

but again, that's more for just, uh, understanding.