Correlation between perinatal asphyxia-induced brain injury, number of enlarged perivascular spaces, and sleep quality in later life

Background Perinatal asphyxia (PA) is increasingly recognized as a significant contributor to neonatal brain injury. Identifying reliable biomarkers for assessing the severity of injury is crucial. Enlarged perivascular spaces (EPVSs), which are considered imaging markers of glymphatic dysfunction are reliable indicators of disease severity and prognosis. However, the application of EPVSs among neonates remains unclear. This study aims to investigate whether numbers of EPVSs can serve as a novel biomarker for the severity of PA-induced brain injury (PABI) and the sleep quality in later life. Methods Neonates ( n = 319) with PA were categorized as mild ( n = 229) or severe ( n = 90). Clinical, amplitude-integrated electroencephalography (aEEG), and cranial magnetic resonance imaging (MRI) data were collected. The sleep quality was assessed using questionnaires via follow-up. Correlation analysis was performed to examine associations between numbers of EPVSs and clinical parameters. Multivariate linear regression analysis was performed to evaluate the independent correlation between numbers of EPVSs and severity of PABI. The correlation between numbers of EPVSs and later sleep quality in infants was also evaluated. Results There were multiple clinical parameters correlated with numbers of EPVSs. Univariate analysis revealed that physiological status, inflammatory markers, and numbers of EPVSs were related with the severity of PABI. Multivariable regression analysis found that numbers of EPVSs independently related with the severity of PABI [ P = 0.0001 in all infants (MRI); P = 0.0248 in mild PA group (MRI); P = 0.0114 in severe PA group (MRI)]. In the severe PA group, numbers of EPVSs were significantly correlated with long-term sleep quality ( P = 0.0061, r = 0.3365), a higher number of EPVSs was associated with more severe sleep disturbance. Conclusions Numbers of EPVSs may serve as a novel imaging biomarker for evaluating the severity of brain injury after PA; this biomarker can predict sleep disorders later in life. Collectively our data suggests that glymphatic dysfunction may contribute to post asphyxia-induced brain injury. Early evaluation of EPVSs could aid in risk stratification and intervention strategies.