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Low-grade germinal matrix-intraventricular hemorrhage (GM-IVH) is the most common complication in extremely premature neonates. The occurrence of GM-IVH is highly associated with hemodynamic instability in the premature brain, yet the long-term impact of low-grade GM-IVH on cerebral blood flow and neuronal health have not been fully investigated. We used an innovative combination of frequency-domain near infrared spectroscopy and diffuse correlation spectroscopy (FDNIRS-DCS) to measure cerebral oxygen saturation (SO 2 ) and an index of cerebral blood flow (CBF i ) at the infant’s bedside and compute an index of cerebral oxygen metabolism (CMRO 2i ). We enrolled twenty extremely low gestational age (ELGA) neonates (seven with low-grade GM-IVH) and monitored them weekly until they reached full-term equivalent age. During their hospital stay, we observed consistently lower CBF i  and CMRO 2i  in ELGA neonates with low-grade GM-IVH compared to neonates without hemorrhages. Furthermore, lower CBF i  and CMRO 2i  in the former group persists even after the resolution of the hemorrhage. In contrast, SO 2  does not differ between groups. Thus, CBF i  and CMRO 2i  may have better sensitivity than SO 2  in detecting GM-IVH-related effects on infant brain development. FDNIRS-DCS methods may have clinical benefit for monitoring the evolution of GM-IVH, evaluating treatment response, and potentially predicting neurodevelopmental outcome.

Reduced cerebral blood flow and oxygen metabolism in extremely preterm neonates with low-grade germinal matrix- intraventricular hemorrhage