Published online May 26, 2009
PEDIATRICS Vol. 123 No. 6 June 2009, pp. 1493-1500 (doi:10.1542/peds.2008-1919)
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ARTICLE

Functional Outcome at School Age of Preterm Infants With Periventricular Hemorrhagic Infarction

Elise Roze, BSca, Koenraad N. J. A. Van Braeckel, MSca, Christa N. van der Veere, MD, PhDa, Carel G. B. Maathuis, MD, PhDb, Albert Martijn, MD, PhDc and Arend F. Bos, MD, PhDa

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

OBJECTIVES. Our objective was to determine motor, cognitive, and behavioral outcome at school age in preterm children with periventricular hemorrhagic infarction and to identify cerebral risk factors for adverse outcome.

METHODS. This was a prospective cohort study of all preterm infants who were <37 weeks' gestation, had periventricular hemorrhagic infarction, and were admitted between 1995 and 2003. Ultrasound scans were reviewed for characteristics of periventricular hemorrhagic infarction and other cerebral abnormalities. At 4 to 12 years of age, motor outcome was assessed by the Gross Motor Function Classification System and the Manual Ability Classification System, by a neurologic examination (Touwen), an intelligence test (Wechsler Intelligence Scale III/Wechsler Preschool and Primary Scale of Intelligence-Revised), and tests for visual-motor integration, visual perception, and verbal memory. Behavior was assessed by using the Child Behavior Checklist and the Behavior Rating Inventory of Executive Function.

RESULTS. Of 38 infants, 15 (39%) died. Twenty-one of the 23 survivors were included in the follow-up. Four infants were neurologically normal, 1 had minor neurologic dysfunction, 13 had unilateral spastic cerebral palsy, and 3 had bilateral cerebral palsy. Coordination, associated movements, and fine manipulative abilities were affected most according to the neurologic examination. Gross Motor Function Classification System scores were level 1 (7 children), level 2 (7 children), level 3 (1 child), and level 4 (2 children). Manual Ability Classification System scores were normal (4 children), level 1 (8 children), level 2 (7 children), and level 3 (2 children). The mean and median total IQ was 83. Visual perception was normal in 88% of children, visuomotor integration was normal in 74%, and verbal memory was normal in 50%. Behavior was normal in 53% of children, and executive functions were normal in 65% and 29% of children (by parent and teacher report, respectively). Characteristics of the periventricular hemorrhagic infarction were not related to functional motor outcome and intelligence. Posthemorrhagic ventricular dilatation was a risk factor for poorer total and performance intelligence and abnormal fine manipulative abilities.

CONCLUSIONS. The majority of surviving preterm children with periventricular hemorrhagic infarction had cerebral palsy with limited functional impairment at school age. Intelligence was within 1 SD of the norm of preterm children without lesions in 60% to 80% of the children. Verbal memory, in particular, was affected. Behavioral and executive function problems occurred slightly more than in preterm infants without lesions. The functional outcome at school age of preterm children with periventricular hemorrhagic infarction is better than previously thought.

Key Words: periventricular hemorrhagic infarction • venous infarction • preterm infants • cerebral hemorrhage • motor outcome • cerebral palsy • GMFCS • cognitive outcome • intelligence • visuomotor integration • visual perception • verbal memory • behavior • executive functioning

Abbreviations: AVLT—Auditory Verbal Learning Test • BRIEF—Behavior Rating Inventory of Executive Function • CBCL—Child Behavior Checklist • CP—cerebral palsy • GMFCS—Gross Motor Function Classification System • GMH—germinal matrix hemorrhage • MACS—Manual Ability Classification System • PHVD—posthemorrhagic ventricular dilatation • PVHI—periventricular hemorrhagic infarction • PVL—periventricular leukomalacia • TVPS—Test of Visual-Perceptual Skills • VMI—Test of Visual-Motor Integration

Accepted Sep 23, 2008.


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Periventricular hemorrhagic infarction in preterm infants: the importance of size and location
Jeroen Dudink, et al.
Pediatrics Online, 11 Sep 2009 [Full text]