Predictors of neurodevelopmental outcomes in preterm infants with intraparenchymal hemorrhage

To determine which neuroimaging, clinical and sociodemographic factors predict neurodevelopment at 18-22 months age among extremely preterm infants with intraparenchymal hemorrhage (IPH).

Cranial ultrasounds performed before 42 days of age and cranial ultrasounds/magnetic resonance images of the brain performed near discharge were reviewed for hemorrhage location and other abnormalities. Clinical and sociodemographic factors were extracted from existing databases. The primary outcome was presence of cerebral palsy (CP) and the secondary outcome was cognitive development (Bayley Scales of Infant Development).

Of 1168 infants (<1000 g or <27 weeks), 141 infants had an IPH and 48 infants were seen in follow-up. All infants with extensive hemorrhages (involving three or more lobes) developed CP. In early imaging (before 42 days of age), ventriculomegaly, intraventricular hemorrhage (IVH) and extensive hemorrhage were predictors of CP. In imaging performed near discharge, ventriculomegaly, intraventricular echodensity and having a ventricular shunt were predictors of CP. Clinical, imaging and sociodemographic factors were not associated with low cognitive score.

In preterm infants surviving with IPH, extensive hemorrhage, ventriculomegaly, IVH and having a shunt increased the risk of developing CP.