Decision-Making for Extremely Preterm Infants With Severe Intraventricular Hemorrhage

Extremely preterm infants are at increased risk for developing an intraventricular hemorrhage in the first few days of life. Higher grades of intraventricular hemorrhage, referred to as severe intraventricular hemorrhage (sIVH), are associated with increased risk of adverse outcomes such as cerebral palsy, other neurodevelopmental impairments, and even death.^1,2 Infants who develop sIVH often have significant cardiorespiratory disease as well. These concurrent clinical factors make it difficult to determine if early death after a diagnosis of sIVH is directly related to the hemorrhage, other clinical factors, or a decision to withdraw support.

In this issue of Pediatrics, McCauley et al³ examine whether sIVH is independently associated with death. They analyzed retrospective data from >32 000 infants born at 22 to 29 weeks’ gestation during a 14-year period and hospitalized in one of 242 Pediatrix Medical Group NICUs. In multivariate analysis, the authors found that infants who …

Address correspondence to Kate A. Tauber, MD, MA, Department of Pediatrics, Bernard and Millie Duker Children’s Hospital, 47 New Scotland Ave, MC101, Albany, NY 12208. E-mail: tauberk{at}amc.edu