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Neurodevelopmental outcome of infants with unilateral or bilateral periventricular hemorrhagic infarction

Nathalie L Maitre1, Diane D Marshall, Wayne A Price

  • 1Department of Pediatrics, Monroe Carell Children's Hospital at Vanderbilt, Nashville, Tennessee 37232-9544, USA. nathalie.maitre@vanderbilt.edu

Pediatrics
|December 2, 2009
PubMed

Insights

Infants with unilateral periventricular hemorrhagic infarction (PVHI) show better neurodevelopmental outcomes than those with bilateral PVHI. Laterality and complications help predict cognitive scores in preterm infants.

Area of Science:

  • Neonatal Neurology
  • Developmental Pediatrics
  • Neuroimaging

Background:

  • Periventricular hemorrhagic infarction (PVHI) significantly impacts neurodevelopmental outcomes in preterm infants.
  • Understanding the prognostic implications of PVHI laterality is crucial for clinical management.

Purpose of the Study:

  • To investigate whether unilateral PVHI is associated with more favorable neurodevelopmental outcomes compared to bilateral PVHI in preterm infants.
  • To develop a predictive model for cognitive impairment (Mental Developmental Index <70) based on PVHI laterality and associated complications.

Main Methods:

  • A multicenter, retrospective study analyzed data from 69 preterm infants (<1500g) with confirmed PVHI on early cranial ultrasonography.
  • Neurodevelopmental outcomes, including Bayley Scales of Infant Development (MDI and PDI), and cerebral palsy were assessed.
  • A predictive model for MDI <70 was constructed using radiologic and clinical variables.

Main Results:

  • Infants with unilateral PVHI demonstrated significantly higher median MDI (82 vs 49) and PDI (53 vs 49) scores compared to those with bilateral PVHI.
  • Unilateral PVHI was associated with a lower likelihood of severe cerebral palsy (aOR: 0.15).
  • The combination of unilateral PVHI with periventricular leukomalacia and retinopathy of prematurity requiring surgery increased the probability of MDI <70 to 89%.

Conclusions:

  • Unilateral PVHI is linked to superior motor and cognitive outcomes in preterm infants compared to bilateral PVHI.
  • A predictive model incorporating PVHI laterality, periventricular leukomalacia, and retinopathy of prematurity can estimate the risk of significant cognitive delay (MDI <70).
  • This model aids clinicians in counseling families regarding neurodevelopmental prognosis.
Abstract

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