Published online June 9, 2008
PEDIATRICS Vol. 122 No. 1 July 2008, pp. e46-e52 (doi:10.1542/peds.2007-3305)
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ARTICLE

Risk Factors for Adverse Outcome in Preterm Infants With Periventricular Hemorrhagic Infarction

Elise Roze, BSca, Jorien M. Kerstjens, MDa, Carel G.B. Maathuis, MD, PhDb, Hendrik J. ter Horst, MDa and Arend F. Bos, MD, PhDa

a Division of Neonatology, Department of Pediatrics
b Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, Netherlands

OBJECTIVE. Our objective was to identify risk factors that were associated with mortality and adverse neurologic outcome at 18 months of age in preterm infants with periventricular hemorrhagic infarction.

METHODS. This was a retrospective cohort study of all preterm infants who were <37 weeks' gestation, had periventricular hemorrhagic infarction, and were admitted between 1995 and 2006. Ultrasound scans were reviewed for grading of germinal matrix hemorrhage, localization and extension of the infarction, and other abnormalities. Several clinical factors were scored. Outcome measures were mortality, cerebral palsy, and Gross Motor Function Classification System level. Odds ratios were calculated by univariate and multivariate logistic regression analyses.

RESULTS. Of 54 infants, 16 (30%) died. Twenty-five (66%) of 38 survivors developed cerebral palsy: 21 mild (Gross Motor Function Classification System levels 1 and 2) and 4 moderate to severe (levels 3 and 4). Several perinatal and neonatal risk factors were associated with mortality. After multivariate logistic regression, only use of inotropic drugs and maternal intrauterine infection were predictors of mortality. In survivors, only the most extended form of periventricular hemorrhagic infarction was associated with the development of cerebral palsy but not with severity of cerebral palsy. Cystic periventricular leukomalacia and concurrent grade 3 germinal matrix hemorrhage were associated with more severe cerebral palsy.

CONCLUSIONS. In preterm infants with periventricular hemorrhagic infarction, mortality occurred despite optimal treatment and was associated with circulatory failure and maternal intrauterine infection. In survivors, motor development was abnormal in 66%, but functional abilities were good in the majority. Extension and localization of the periventricular hemorrhagic infarction were not related to functional outcome.

Key Words: periventricular hemorrhagic infarction • venous infarction • preterm infants • cerebral hemorrhage • perinatal risk factors • mortality • cerebral palsy • GMFCS

Abbreviations: PVHI—periventricular hemorrhagic infarction • GMH—germinal matrix hemorrhage • CP—cerebral palsy • PHVD—posthemorrhagic ventricular dilation • PVL—periventricular leukomalacia • GMFCS—Gross Motor Function Classification System • OR—odds ratio

Accepted Jan 9, 2008.


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eLetters:

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Periventricular hemorrhagic infarction in preterm infants: the importance of size and location
Jeroen Dudink, et al.
Pediatrics Online, 14 Jul 2009 [Full text]