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Functional outcome at school age of preterm infants with periventricular hemorrhagic infarction
Elise Roze1, Koenraad N J A Van Braeckel, Christa N van der Veere
1Department of Pediatrics, Division of Neonatology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, Netherlands. e.roze@bkk.umcg.nl
Insights
Most preterm children with periventricular hemorrhagic infarction survive and have cerebral palsy with limited impairment. Verbal memory and executive functions are often affected, but overall outcomes are better than previously believed.
Area of Science:
- Neonatal Neurology
- Developmental Pediatrics
- Neurodevelopmental Outcomes
Background:
- Periventricular hemorrhagic infarction (PHI) is a significant cause of brain injury in preterm infants.
- Understanding the long-term neurodevelopmental consequences of PHI is crucial for clinical management and intervention.
Purpose of the Study:
- To assess school-age motor, cognitive, and behavioral outcomes in preterm children with PHI.
- To identify specific cerebral risk factors associated with adverse neurodevelopmental outcomes in this population.
Main Methods:
- Prospective cohort study of preterm infants (<37 weeks gestation) with PHI.
- Detailed review of ultrasound scans for PHI characteristics and other cerebral abnormalities.
- Comprehensive neurodevelopmental assessments at 4-12 years, including motor function, intelligence, visual-motor integration, verbal memory, and behavior.
Main Results:
- Of 38 infants, 15 died; 21 survivors were assessed.
- The majority of survivors (17/21) had cerebral palsy (spastic or bilateral).
- Intelligence quotient (IQ) was within 1 SD of the norm for 60-80% of children; verbal memory and executive functions were frequently impaired.
- Posthemorrhagic ventricular dilatation was linked to poorer intelligence and fine motor skills.
Conclusions:
- Preterm children with PHI often exhibit cerebral palsy but with generally limited functional impairment at school age.
- While cognitive and behavioral challenges exist, particularly in verbal memory and executive functions, overall outcomes are more favorable than previously reported.
- Posthemorrhagic ventricular dilatation is a key risk factor for poorer neurodevelopmental outcomes in this cohort.
Objectives:
Our objective was to determine motor, cognitive, and behavioral outcome at school age in preterm children with periventricular hemorrhagic infarction and to identify cerebral risk factors for adverse outcome.
Methods:
This was a prospective cohort study of all preterm infants who were <37 weeks' gestation, had periventricular hemorrhagic infarction, and were admitted between 1995 and 2003. Ultrasound scans were reviewed for characteristics of periventricular hemorrhagic infarction and other cerebral abnormalities. At 4 to 12 years of age, motor outcome was assessed by the Gross Motor Function Classification System and the Manual Ability Classification System, by a neurologic examination (Touwen), an intelligence test (Wechsler Intelligence Scale III/Wechsler Preschool and Primary Scale of Intelligence-Revised), and tests for visual-motor integration, visual perception, and verbal memory. Behavior was assessed by using the Child Behavior Checklist and the Behavior Rating Inventory of Executive Function.
Results:
Of 38 infants, 15 (39%) died. Twenty-one of the 23 survivors were included in the follow-up. Four infants were neurologically normal, 1 had minor neurologic dysfunction, 13 had unilateral spastic cerebral palsy, and 3 had bilateral cerebral palsy. Coordination, associated movements, and fine manipulative abilities were affected most according to the neurologic examination. Gross Motor Function Classification System scores were level 1 (7 children), level 2 (7 children), level 3 (1 child), and level 4 (2 children). Manual Ability Classification System scores were normal (4 children), level 1 (8 children), level 2 (7 children), and level 3 (2 children). The mean and median total IQ was 83. Visual perception was normal in 88% of children, visuomotor integration was normal in 74%, and verbal memory was normal in 50%. Behavior was normal in 53% of children, and executive functions were normal in 65% and 29% of children (by parent and teacher report, respectively). Characteristics of the periventricular hemorrhagic infarction were not related to functional motor outcome and intelligence. Posthemorrhagic ventricular dilatation was a risk factor for poorer total and performance intelligence and abnormal fine manipulative abilities.
Conclusions:
The majority of surviving preterm children with periventricular hemorrhagic infarction had cerebral palsy with limited functional impairment at school age. Intelligence was within 1 SD of the norm of preterm children without lesions in 60% to 80% of the children. Verbal memory, in particular, was affected. Behavioral and executive function problems occurred slightly more than in preterm infants without lesions. The functional outcome at school age of preterm children with periventricular hemorrhagic infarction is better than previously thought.
