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Published on: November 20, 2015
Intracranial Hemorrhage and 2-Year Neurodevelopmental Outcomes in Infants Born Extremely Preterm
Janessa B Law1, Thomas R Wood1, Semsa Gogcu2
1Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA.
Insights
Intracranial hemorrhage (ICH) affects 38% of extremely preterm infants. Severe ICH is linked to higher risks of death or neurodevelopmental impairment at two years.
Area of Science:
- Neonatalogy
- Pediatric Neurology
- Medical Ultrasound
Background:
- Extremely preterm infants (24 to 27 weeks gestational age) face significant risks of intracranial hemorrhage (ICH).
- Understanding the incidence, progression, and risk factors of ICH is crucial for improving outcomes.
- The association between ICH and long-term neurodevelopmental impairment (NDI) requires further characterization.
Purpose of the Study:
- To determine the incidence, timing, progression, and risk factors for intracranial hemorrhage (ICH) in infants born between 24 and 27 weeks gestational age.
- To characterize the association between ICH and death or neurodevelopmental impairment (NDI) at 2 years of corrected age.
Main Methods:
- Serial cranial ultrasound scans were performed on 883 infants at day 1, day 7-9, and 36 weeks postmenstrual age.
- Potential risk factors for ICH development were examined.
- Outcomes included death or severe NDI and neurodevelopmental assessment using the Bayley Scales of Infant and Toddler Development, 3rd Edition, at 2 years corrected age.
Main Results:
- ICH was identified in 38% of enrolled infants.
- Risk factors for ICH varied by timing; multiple gestation and cesarean delivery reduced early ICH risk, while prenatal steroids decreased later ICH.
- Bilateral and higher-grade ICH at 7-9 days or 36 weeks postmenstrual age were associated with increased risk of death or severe NDI and lower cognitive scores.
Conclusions:
- Risk factors for intracranial hemorrhage in extremely preterm infants are time-dependent.
- Bilateral and increasing grades of ICH are significantly associated with adverse outcomes, including death or neurodevelopmental impairment at two years corrected age.
Objectives:
To determine the incidence, timing, progression, and risk factors for intracranial hemorrhage (ICH) in infants 240/7 to 276/7 weeks of gestational age and to characterize the association between ICH and death or neurodevelopmental impairment (NDI) at 2 years of corrected age.
Study Design:
Infants enrolled in the Preterm Erythropoietin Neuroprotection Trial had serial cranial ultrasound scans performed on day 1, day 7-9, and 36 weeks of postmenstrual age to evaluate ICH. Potential risk factors for development of ICH were examined. Outcomes included death or severe NDI as well as Bayley Scales of Infant and Toddler Development, 3rd Edition, at 2 years of corrected age.
Results:
ICH was identified in 38% (n = 339) of 883 enrolled infants. Multiple gestation and cesarean delivery reduced the risk of any ICH on day 1. Risk factors for development of bilateral Grade 2, Grade 3, or Grade 4 ICH at day 7-9 included any ICH at day 1; 2 or more doses of prenatal steroids decreased risk. Bilateral Grade 2, Grade 3, or Grade 4 ICH at 36 weeks were associated with previous ICH at day 7-9. Bilateral Grade 2, any Grade 3, and any Grade 4 ICH at 7-9 days or 36 weeks of postmenstrual age were associated with increased risk of death or severe NDI and lower Bayley Scales of Infant and Toddler Development, 3rd Edition, scores.
Conclusions:
Risk factors for ICH varied by timing of bleed. Bilateral and increasing grade of ICH were associated with death or NDI in infants born extremely preterm.
