Divergent Pontine and Cerebellar Pathology in Preterm Infants With Necrotizing Enterocolitis

NEC in preterm infants is linked to a higher prevalence of pontine MRI abnormalities (12.4% vs 1.1%; adjusted prevalence ratio 9.14) alongside cerebellar and callosal changes.

• Why it matters: Preterm NEC survivors often develop neurodevelopmental impairment, yet the regional brain timing and cellular/molecular drivers of injury are not well characterized.
• What they did: In a prospective cohort (2012–2024) at Children’s National Hospital, 253 infants (<37 weeks; 128 NEC, 125 controls) underwent term-equivalent MRI, serial ultrasound, plasma metabolomics, and postmortem tissue analyses; hindbrain growth was tracked from a mean NEC onset age of 29 weeks’ postmenstrual age.
• The result: Pontine pathology showed neuronal injury with increased apoptotic burden and neuroinflammatory, reduced mitochondrial programs, while cerebellar pathology showed external granular layer contraction (42% reduction; P=.04) with reduced metabolic/cell-cycle programs and lysophospholipid depletion; cerebellar deficits appeared earlier and pontine growth decelerated later.

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