Published online October 1, 2007
PEDIATRICS Vol. 120 No. 4 October 2007, pp. 785-792 (doi:10.1542/10.1542/peds.2007-0211)
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ARTICLE

Neurodevelopmental Outcome in Survivors of Periventricular Hemorrhagic Infarction

Haim Bassan, MDa, Catherine Limperopoulos, PhDa, Karen Visconti, PhDb, D. Luisa Mayer, PhDc, Henry A. Feldman, PhDd, Lauren Avery, PhDe, Carol B. Benson, MDf, Jane Stewart, MDe, Steven A. Ringer, MD, PhDg, Janet S. Soul, MD, CMa, Joseph J. Volpe, MDa and Adré J. du Plessis, MBChB, MPHa

a Department of Neurology, Fetal-Neonatal Neurology Research Group
b Departments of Cardiology
c Ophthalmology
d Clinical Research Program, Department of Pediatrics
e Infant Follow-up Program, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts
f Departments of Radiology
g Neonatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts

OBJECTIVES. Periventricular hemorrhagic infarction is a serious complication of germinal matrix-intraventricular hemorrhage in premature infants. Our objective was to determine the neurodevelopmental and adaptive outcomes of periventricular hemorrhagic infarction survivors and identify early cranial ultrasound predictors of adverse outcome.

METHODS. We retrospectively evaluated all cranial ultrasounds of 30 premature infants with periventricular hemorrhagic infarction and assigned a cranial ultrasound–based periventricular hemorrhagic infarction severity score (range: 0–3) on the basis of whether periventricular hemorrhagic infarction (1) involved ≥2 territories, (2) was bilateral, or (3) caused midline shift. We then performed neuromotor, visual function, and developmental evaluations (Mullen Scales of Early Learning, Vineland Adaptive Behavior Scale). Developmental scores below 2 SD from the mean were defined as abnormal.

RESULTS. Median adjusted age at evaluation was 30 months (range: 12–66 months). Eighteen subjects (60%) had abnormal muscle tone, and 7 (26%) had visual field defects. Developmental delays involved gross motor (22 [73%]), fine motor (17 [59%]), visual receptive (13 [46%]), expressive language (11 [38%]), and cognitive (14 [50%]) domains. Impairment in daily living and socialization was documented in 10 (33%) and 6 (20%) infants, respectively. Higher cranial ultrasound–based periventricular hemorrhagic infarction severity scores predicted microcephaly and abnormalities in gross motor, visual receptive, and cognitive function.

CONCLUSIONS. In the current era, two thirds of periventricular hemorrhagic infarction survivors develop significant cognitive and/or motor abnormalities, whereas adaptive skills are relatively spared. Higher cranial ultrasound–based periventricular hemorrhagic infarction severity scores predict worse outcome in several modalities and may prove to be a valuable tool for prognostication.

Key Words: ultrasonography • grade IV intraventricular hemorrhage • premature infants • outcome • score

Abbreviations: PVHI—periventricular hemorrhagic infarction • GM-IVH—germinal matrix-intraventricular hemorrhage • CUS—cranial ultrasound • PVL—periventricular leukomalacia • CI—confidence interval

Accepted Apr 30, 2007.


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