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Neurodevelopmental outcome in children with intraventricular hemorrhage
Yasuyuki Futagi1, Yasuhisa Toribe, Kana Ogawa
1Division of Pediatric Neurology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan. jqfkk025@yahoo.co.jp
Insights
Neurodevelopmental outcomes for children with intraventricular hemorrhage (IVH) show significant differences based on IVH grade. Severe IVH (grade 4) is linked to high rates of cerebral palsy and poor outcomes, with no clear improvement over two decades.
Area of Science:
- Neonatal neurology
- Pediatric neurodevelopment
- Perinatal medicine
Background:
- Intraventricular hemorrhage (IVH) is a common complication in preterm infants.
- Neurodevelopmental outcomes in affected children can vary significantly.
- Long-term follow-up is crucial for understanding the impact of IVH.
Purpose of the Study:
- To assess the long-term neurodevelopmental outcomes in a cohort of children with intraventricular hemorrhage.
- To investigate the relationship between the severity (grade) of IVH and specific neurodevelopmental outcomes.
- To determine if neurodevelopmental outcomes have improved over time in children with IVH.
Main Methods:
- A consecutive cohort of 335 children born between 1981 and 1999 with intraventricular hemorrhage was followed.
- Neurodevelopmental outcomes, including cerebral palsy, mental retardation, and intelligence levels, were assessed.
- Outcomes were analyzed in relation to the grade of intraventricular hemorrhage and birth decade.
Main Results:
- Normal neurodevelopmental outcomes were observed in 56.1% of children.
- Cerebral palsy occurred in 22.4%, mental retardation in 10.2%, and borderline intelligence in 11.3%.
- Higher grades of IVH were significantly associated with poorer outcomes; Grade 4 IVH had a 71.2% rate of cerebral palsy and only 15.4% normal outcomes, compared to 70% normal outcomes for Grade 1 IVH. Epilepsy incidence was 11.6%.
Conclusions:
- Neurodevelopmental outcomes in children with intraventricular hemorrhage are strongly dependent on the initial severity of the hemorrhage.
- Children with severe IVH (Grade 4) face a high risk of significant long-term disabilities.
- This study did not find evidence of improved neurodevelopmental outcomes for children with IVH from the 1980s to the 1990s.
Abstract:
To clarify the neurodevelopmental outcome in children with intraventricular hemorrhage, a follow-up study was performed for a consecutive group of 335 subjects in one tertiary center born between 1981 and 1999. Their mean gestation and birth weight were 28.1 weeks and 1162.2 gm, respectively. The follow-up period ranged from 3 to 20 years (mean: 7.5 years). The neurodevelopmental outcomes were normal in 188 (56.1%), cerebral palsy in 75 (22.4%), mental retardation in 34 (10.2%), and borderline intelligence in 38 (11.3%). There were statistically significant differences in the outcomes among the groups with different grades of intraventricular hemorrhage. Approximately 70% of the children with intraventricular hemorrhage grade 1 were normal, whereas only 15.4% of the children with intraventricular hemorrhage grade 4 were normal. Cerebral palsy was associated with as high as 71.2% in the patients with intraventricular hemorrhage grade 4. The overall incidence of epilepsy was 39/335 (11.6%). This study has not demonstrated clear improvement of the outcome in children with intraventricular hemorrhage between the 1980s and 1990s.
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