Periventricular/Intraventricular Hemorrhage and Neurodevelopmental Outcomes: A Meta-analysis

CONTEXT: Periventricular/intraventricular hemorrhage (PIVH) is a common short-term morbidity in preterm infants, but its long-term neurodevelopmental impact, particularly with mild PIVH, remains unclear.

OBJECTIVE: To systematically review and meta-analyze the neurodevelopmental outcomes of preterm infants ≤34 weeks’ gestation with mild and severe PIVH, compared with no PIVH.

DATA SOURCES: Medline, Embase, CINAHL, and PsychINFO databases from January 2000 through June 2014.

STUDY SELECTION: Studies reporting long-term neurodevelopmental outcomes based on severity of PIVH were included.

DATA EXTRACTION: Study characteristics, inclusion/exclusion criteria, exposures, and outcome assessment data extracted independently by 2 coauthors.

RESULTS: The pooled unadjusted odds ratios of the primary outcome of death or moderate-severe neurodevelopmental impairment (NDI) were higher with both mild (1.48, 95% CI 1.26–1.73; 2 studies) and severe PIVH (4.72, 4.21–5.31; 3 studies); no studies reported adjusted odds ratios. Among survivors, odds of moderate-severe NDI were higher with mild and severe PIVH in both unadjusted (1.75, 1.40–2.20; 3 studies; 3.36, 3.06–3.68; 5 studies) and adjusted (1.39, 1.09–1.77; 3 studies; 2.44, 1.73–3.42; 2 studies) pooled analyses. Adjusted odds of cerebral palsy and cognitive delay were higher with severe but not mild PIVH.

LIMITATIONS: Only observational studies were included. Fifteen of 21 included studies had a moderate-high risk of bias.

CONCLUSIONS: Mild and severe PIVH are associated with progressively higher odds of death or moderate-severe NDI compared with no PIVH, but no studies adjusted for confounders. Among survivors, mild PIVH was associated with higher odds of moderate-severe NDI compared with no PIVH.