Intraventricular Hemorrhage and Neurodevelopmental Outcomes in Extreme Preterm Infants
OBJECTIVE: Not many large studies have reported the true impact of lower-grade intraventricular hemorrhages in preterm infants. We studied the neurodevelopmental outcomes of extremely preterm infants in relation to the severity of intraventricular hemorrhage.
METHODS: A regional cohort study of infants born at 23 to 28 weeks’ gestation and admitted to a NICU between 1998 and 2004. Primary outcome measure was moderate to severe neurosensory impairment at 2 to 3 years’ corrected age defined as developmental delay (developmental quotient >2 SD below the mean), cerebral palsy, bilateral deafness, or bilateral blindness.
RESULTS: Of the 1472 survivors assessed, infants with grade III–IV intraventricular hemorrhage (IVH; n = 93) had higher rates of developmental delay (17.5%), cerebral palsy (30%), deafness (8.6%), and blindness (2.2%). Grade I–II IVH infants (n = 336) also had increased rates of neurosensory impairment (22% vs 12.1%), developmental delay (7.8% vs 3.4%), cerebral palsy (10.4% vs 6.5%), and deafness (6.0% vs 2.3%) compared with the no IVH group (n = 1043). After exclusion of 40 infants with late ultrasound findings (periventricular leukomalacia, porencephaly, ventricular enlargement), isolated grade I–II IVH (n = 296) had increased rates of moderate-severe neurosensory impairment (18.6% vs 12.1%). Isolated grade I–II IVH was also independently associated with a higher risk of neurosensory impairment (adjusted odds ratio 1.73, 95% confidence interval 1.22–2.46).
CONCLUSIONS: Grade I–II IVH, even with no documented white matter injury or other late ultrasound abnormalities, is associated with adverse neurodevelopmental outcomes in extremely preterm infants.
- ACT —
- Australian Capital Territory
- BSIDII-MDI —
- Bayley Scales of Infant Development-II Mental Development Index
- CI —
- confidence interval
- GMDS-GQ —
- Griffiths Mental Developmental Scale General Quotient
- IVH —
- intraventricular hemorrhage
- MDI —
- mental developmental index
- NICUS —
- Neonatal Intensive Care Units database
- NSW —
- New South Wales
- PVL —
- periventricular leukomalacia
- ROP —
- retinopathy of prematurity
- Accepted October 1, 2013.
- Copyright © 2014 by the American Academy of Pediatrics