Correlation between diffusion tensor imaging and histological brain injury in ventilated preterm lambs

Introduction Many preterm neonates require mechanical ventilation immediately after birth to facilitate lung aeration and gas exchange, and to trigger the cardiovascular transition [1]. Despite the necessity of resuscitation, the initiation of mechanical ventilation can cause brain injury in preterm neonates, particularly if delivered with injurious high tidal volumes [2,3]. Intrauterine inflammation (chorioamnionitis) is an antecedent of preterm birth and is present in up to two-thirds of extremely preterm infants [4]. Chorioamnionitis increases white matter injury and confers a four-fold increased risk of cerebral palsy [5,6]. Given the frequency of chorioamnionitis and the high requirement for mechanical ventilation, a large proportion of preterm infants are exposed to both intrauterine inflammation and mechanical ventilation. Preclinical studies have revealed that this combination of risk factors exacerbates brain inflammation and the resultant injury, which can be detected histologically within the first hours after birth [7,8].