Neurodevelopmental outcome of preterm infants with ventricular dilatation with and without associated haemorrhage

Area of Science:

• Neonatal Neurology
• Pediatric Neurodevelopment
• Perinatal Medicine

Background:

• Ventricular dilatation (VD) is a known complication in preterm infants.
• Germinal matrix haemorrhage--intraventricular haemorrhage (GMH-IVH) is another common neonatal brain injury.
• The combined impact of VD and GMH-IVH on long-term neurodevelopment requires further investigation.

Purpose of the Study:

• To determine if the presence of GMH-IVH alongside VD in preterm infants affects neurodevelopmental outcomes at 8 years of age.
• To compare outcomes between preterm infants with VD only, VD with GMH-IVH, and those with normal neonatal ultrasounds.

Main Methods:

• Longitudinal study of 699 preterm infants (<33 weeks gestation) categorized by neonatal cranial ultrasound findings (normal, VD, VD with GMH-IVH).
• Neurodevelopmental assessment at 8 years included neurological examination, Test of Motor Impairment (TOMI), Test of Visuo-Motor Integration (VMI), and Wechsler Intelligence Scales for Children.
• Statistical analysis compared outcomes across the three groups.

Main Results:

• Children with both VD and GMH-IVH had a higher proportion of disabling impairments.
• Poorer performance on TOMI and VMI was observed in the VD and GMH-IVH group, even without disabling impairments.
• This group also exhibited significantly lower performance IQ compared to infants with normal scans; VD alone did not significantly alter IQ.
• These findings suggest subtle white matter injury not detected by neonatal ultrasound.

Conclusions:

• The combination of VD and GMH-IVH in preterm infants is associated with significantly worse neurodevelopmental outcomes at age 8.
• Subtle white matter injury, potentially mediated by factors like non-protein-bound iron, may contribute to these deficits.
• Neonatal cranial ultrasound may underestimate the extent of brain injury in some preterm infants.