Prognostic Significance of Low-Grade Intraventricular Hemorrhage in the Current Era of Neonatology Prognostic Significance of Low-Grade IVH

Sola-Visner M. — Wed, 01 May 2013 00:00:00 GMT

Cranial ultrasonography (CUS) is performed routinely in extremely preterm infants admitted to the neonatal intensive care unit (NICU), and periventricular-intraventricular hemorrhages (PIVHs) are found in approximately 30% of infants born at less than 29 weeks' gestation. Compared with infants with no hemorrhages, infants with intraventricular hemorrhages leading to ventricular dilatation (grade 3 in the Papile classification) or infants with intraparenchymal hemorrhages (grade 4) clearly have higher incidences of cerebral palsy and worse cognitive outcomes. However, the significance of isolated small hemorrhages confined to the germinal matrix (grade 1) or of intraventricular hemorrhages without ventricular dilatation (grade 2) has been less clearly established. Studies evaluating the outcome of infants with these findings have been sparse and have yielded controversial results, and thus there is variability in how the significance of these low-grade hemorrhages is interpreted by neonatologists and conveyed to the parents.

Neurodevelopmental Outcomes of Extremely Low-Gestational-Age Neonates With Low-Grade Periventricular-Intraventricular Hemorrhage Outcomes of Neonates With Ventricular Hemorrhage

Payne AH, Hintz SR, Hibbs A, et al. — Wed, 01 May 2013 00:00:00 GMT

Importance

Low-grade periventricular-intraventricular hemorrhage is a common neurologic morbidity among extremely low-gestational-age neonates, yet the outcomes associated with this morbidity are not fully understood. In a contemporary multicenter cohort, we evaluated the impact of such hemorrhages on early (18-22 month) neurodevelopmental outcomes of extremely premature infants.

Objective

To compare neurodevelopmental outcomes at 18 to 22 months' corrected age for extremely low-gestational-age infants with low-grade (grade 1 or 2) periventricular-intraventricular hemorrhage with those of infants with either no hemorrhage or severe (grade 3 or 4) hemorrhage demonstrated on cranial ultrasonography.

Design

Longitudinal observational study.

Setting

Sixteen centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.

Participants

A total of 1472 infants born at less than 27 weeks' gestational age between January 1, 2006, and December 31, 2008, with ultrasonography results within the first 28 days of life and surviving to 18 to 22 months with complete follow-up assessments were eligible.

Main Exposure

Low-grade periventricular-intraventricular hemorrhage.

Main Outcome Measures

Outcomes included cerebral palsy; gross motor functional limitation; cognitive and language scores according to the Bayley Scales of Infant Development, 3rd Edition; and composite measures of neurodevelopmental impairment. Regression modeling evaluated the association of hemorrhage severity with adverse outcomes while controlling for potentially confounding variables and center differences.

Results

Low-grade hemorrhage was not associated with significant differences in unadjusted or adjusted risk of any adverse neurodevelopmental outcome compared with infants without hemorrhage. Compared with low-grade hemorrhage, severe hemorrhage was associated with decreased adjusted continuous cognitive (β, −3.91 [95% CI, −6.41 to −1.42]) and language (β, −3.19 [−6.19 to −0.19]) scores as well as increased odds of each adjusted categorical outcome except severe cognitive impairment (odds ratio [OR], 1.46 [0.74 to 2.88]) and mild language impairment (OR, 1.35 [0.88 to 2.06]).

Conclusions and Relevance

At 18 to 22 months, the neurodevelopmental outcomes of extremely low-gestational-age infants with low-grade periventricular-intraventricular hemorrhage are not significantly different from those without hemorrhage. Additional study at school age and beyond would be informative.

JAMA Pediatrics: Child Development Topic Collection

Prognostic Significance of Low-Grade Intraventricular Hemorrhage in the Current Era of Neonatology Prognostic Significance of Low-Grade IVH

Neurodevelopmental Outcomes of Extremely Low-Gestational-Age Neonates With Low-Grade Periventricular-Intraventricular Hemorrhage Outcomes of Neonates With Ventricular Hemorrhage