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Intraventricular hemorrhage and developmental outcomes at 24 months of age in extremely preterm infants
T Michael O'Shea1, Elizabeth N Allred, Karl C K Kuban
1Wake Forest School of Medicine, Winston-Salem, NC, USA.
Insights
Intraventricular hemorrhage in premature infants rarely leads to developmental issues alone. White matter lesions, however, significantly increase risks for cerebral palsy and impairments in premature infants.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
- Neuroimaging in neonates
Background:
- Intraventricular hemorrhage (IVH) is a common complication in premature infants.
- The association between IVH and long-term developmental outcomes remains debated.
- White matter abnormalities (WMAs) are also prevalent in this population.
Purpose of the Study:
- To investigate the independent and combined risks of IVH and WMAs on adverse developmental outcomes in extremely premature infants.
- To clarify the specific developmental sequelae associated with isolated IVH versus WMAs.
Main Methods:
- Brain ultrasound was used to identify IVH and WMAs in 1064 infants born before 28 weeks' gestation.
- Developmental outcomes were assessed at 24 months using standardized neurologic examinations and the Bayley Scales of Infant Development.
- Logistic regression models adjusted for gestational age, sex, and insurance status.
Main Results:
- Isolated IVH was associated only with visual fixation difficulties.
- WMAs, when present without IVH, significantly increased the risk of cerebral palsy, low Bayley Mental and Motor Scores, and visual and hearing impairments.
- IVH accompanied or followed by WMAs showed increased risks, but isolated IVH had minimal impact.
Conclusions:
- Intraventricular hemorrhage alone poses a minimal risk for adverse developmental outcomes in premature infants.
- White matter lesions are a stronger predictor of significant neurodevelopmental deficits than isolated IVH.
- The presence of white matter lesions is critical in determining the overall developmental prognosis for premature infants with or without IVH.
Abstract:
Whether intraventricular hemorrhage increases the risk of adverse developmental outcome among premature infants is controversial. Using brain ultrasound, we identified intraventricular hemorrhage and white matter abnormalities among 1064 infants born before 28 weeks' gestation. We identified adverse developmental outcomes at 24 months of age using a standardized neurologic examination and the Bayley Scales of Infant Development Mental and Motor Scales. In logistic regression models that adjusted for gestational age, sex, and public insurance, isolated intraventricular hemorrhage was associated with visual fixation difficulty but no other adverse outcome. Infants who had a white matter lesion unaccompanied by intraventricular hemorrhage were at increased risk of cerebral palsy, low Mental and Motor Scores, and visual and hearing impairments. Except when accompanied or followed by a white matter lesion, intraventricular hemorrhage is associated with no more than a modest increase (and possibly no increase) in the risk of adverse developmental outcome during infancy.
