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11-03-2013 | Neurology | Article

Intraventricular hemorrhage grade prognostic for preterm infants

Abstract

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medwireNews: Study findings published in JAMA Pediatrics suggest that high-risk preterm infants who develop grade 1 or 2 periventricular-intraventricular hemorrhage (PIVH) have comparable neurodevelopmental outcomes to infants with no hemorrhage.

Allison Payne (Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA) and colleagues say that although the presence of severe PIVH strongly correlates with adverse motor and cognitive outcomes, "outcomes of survivors with low-grade PIVH (grade 1 or 2) are less fully understood despite accounting for 50% to 80% of all PIVH cases."

The current study findings that low-grade PIVH is not associated with adverse neurodevelopmental outcomes are in disagreement with previous studies, which have shown a negative effect. In an associated editorial, Martha Sola-Visner (Harvard Medical School, Massachusetts, USA) suggests that this discrepancy is a result of differences in study populations and evolving practices around the use of steroids in neonatology.

For the study, the researchers analyzed 1472 extremely preterm infants admitted to 16 centers from 2006 to 2008 who survived to 18-22 months and had at least one cranial ultrasonography performed during their stay.

In total, 451 infants were diagnosed with PIVH, of which 31% were classified as having grade 1 PIVH, 29% as having grade 2, and 40% as having grade 3 or 4. Infants with grade 1 or 2 PIVH did not have an increased incidence of poor neurodevelopmental outcomes at 18-22 months compared with infants without PIVH, even after multivariate analysis controlling for potential confounders, including the use of antenatal and postnatal steroids.

Compared with low-grade hemorrhage, severe (grade 3 or 4) hemorrhage was significantly associated with cognitive deficits and language delay, as well as an increased risk for poor nonsensory outcomes (including cerebral palsy) apart from mild language impairment and severe cognitive impairment.

The researchers caution that high-prevalence, low-severity disabilities, such as attention deficit/hyperactivity disorders, specific neuropsychological deficits, and behavioral problems may gradually emerge over the years. "It is not clear what contribution low-grade PIVH may have to these more subtle disabilities," they say.

Sola-Visner notes: "It will be important to follow this cohort of infants and perform neurodevelopmental assessments at school age."

By Ingrid Grasmo, medwireNews Reporter

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