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Published on: November 20, 2015
Early-onset intraventricular hemorrhage in preterm neonates: incidence of neurodevelopmental handicap
1Department of Pediatrics, Brown University School of Medicine, Providence, RI, USA.
Insights
Very low birth weight infants with early intraventricular hemorrhage (IVH) face higher risks of cognitive and motor impairments. Early IVH significantly impacts neurodevelopmental outcomes by 3 years corrected age.
Area of Science:
- Neonatal Medicine
- Neurodevelopmental Pediatrics
- Pediatric Neurology
Background:
- Early-onset intraventricular hemorrhage (IVH) is a significant concern in very low birth weight (VLBW) infants.
- Neurodevelopmental outcomes for VLBW infants with early IVH require further investigation.
Purpose of the Study:
- To compare the neurodevelopmental outcomes at 3 years corrected age in VLBW infants with and without early-onset IVH.
- To assess the impact of early IVH on cognitive and motor functions in preterm infants.
Main Methods:
- A multicenter, prospective randomized controlled trial cohort was analyzed.
- Infants (birth weight 600-1,250 g) underwent neurodevelopmental assessment using the Stanford-Binet Intelligence Scale and neurological examinations at 3 years corrected age.
- Early-onset IVH was identified via echoencephalography within the first 6 postnatal hours.
Main Results:
- Infants with early IVH had lower survival rates to 3 years corrected age (75% vs. 89%, P<.001).
- Children with early IVH showed significantly higher rates of low intelligence quotient (IQ < 70) (38% vs. 19%, P=.03).
- Cerebral palsy was more prevalent in infants with early IVH (25% vs. 8%, P=.01).
Conclusions:
- Early-onset IVH in VLBW infants is associated with a high risk of adverse neurodevelopmental outcomes.
- Cognitive deficits and motor impairments, including cerebral palsy, are significantly more common in infants experiencing early IVH.
- These findings underscore the importance of interventions to prevent or mitigate early IVH in preterm infants.
Abstract:
The neurodevelopmental outcome of very low birth weight infants experiencing early-onset intraventricular hemorrhage (IVH) occurring within the first 6 postnatal hours was compared with that of their peers without early-onset IVH at 3 years corrected age. The 440 surviving preterm infants (birth weight 600 to 1,250 g) who had been enrolled in a multicenter, prospectively randomized, controlled trial evaluating the efficacy of postnatal indomethacin to prevent IVH were evaluated with the Stanford-Binet Intelligence Scale and neurological examinations at 3 years corrected age. All study infants had echoencephalography between 5 and 11 hours of life, and testing is reported for all children residing in English monolingual households at 3 years corrected age (i.e., from the obstetric due date). Fifty five of the 73 (75%) infants with IVH within the first 5 to 11 hours survived to 3 years of age, compared with 385 of the 432 (89%) children without early-onset hemorrhage who were alive at 3 years corrected age (P<.001). Eleven of the 29 (38%) English monolingual children with early-onset IVH had Stanford-Binet intelligence quotient scores of less than 70, compared with 47 of the 249 (19%) children without early IVH (P = .03). Similarly, 7 of 28 (25%) early IVH children were found to have cerebral palsy, compared with 20 of 241 (8%) children without early IVH (P = .01). These data suggest that infants who experience the early onset of IVH are at high risk for both cognitive and motor handicaps at 3 years corrected age.
