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Published on: November 20, 2015
Preterm Brain Injury and Neurodevelopmental Outcomes: A Meta-analysis
Philippa Rees1, Caitriona Callan2, Karan R Chadda3
1Population Policy and Practice, Great Ormond Street UCL Institute of Child Health, London, United Kingdon.
Insights
Preterm infants with intraventricular hemorrhage (IVH) or white matter injury (WMI) face increased risks of neurodevelopmental impairment. Early identification and intervention are crucial for improving outcomes in these vulnerable infants.
Area of Science:
- Neonatal Neurology
- Developmental Pediatrics
- Neuroscience
Background:
- Preterm brain injuries, including intraventricular hemorrhage (IVH) and white matter injury (WMI), are significant concerns in neonatal care.
- Neurodevelopmental outcomes for preterm infants are continually evolving with advancements in neonatal care.
Approach:
- A systematic review and meta-analysis were conducted to evaluate neurodevelopmental outcomes in preterm infants with IVH or WMI.
- Literature searches across 10 databases (2000-2021) identified observational studies reporting 3-year neurodevelopmental outcomes.
Key Points:
- Increased risks of moderate-severe neurodevelopmental impairment were observed with IVH grades 1-2 (aOR 1.35) and 3-4 (aOR 4.26).
- Children with IVH experienced higher risks of cerebral palsy, cognitive, hearing, and visual impairments.
- White matter injury (WMI) was associated with substantially higher risks of cerebral palsy, motor, and cognitive impairments.
Conclusions:
- Mild IVH, severe IVH, and WMI are linked to adverse neurodevelopmental outcomes in preterm infants.
- Standardized core outcome sets and open-access data are needed to better understand these complex outcomes.
Context:
Preterm brain injuries are common; neurodevelopmental outcomes following contemporary neonatal care are continually evolving.
Objective:
To systematically review and meta-analyze neurodevelopmental outcomes among preterm infants after intraventricular hemorrhage (IVH) and white matter injury (WMI).
Data Sources:
Published and grey literature were searched across 10 databases between 2000 and 2021.
Study Selection:
Observational studies reporting 3-year neurodevelopmental outcomes for preterm infants with IVH or WMI compared with preterm infants without injury.
Data Extraction:
Study characteristics, population characteristics, and outcome data were extracted.
Results:
Thirty eight studies were included. There was an increased adjusted risk of moderate-severe neurodevelopmental impairment after IVH grade 1 to 2 (adjusted odds ratio 1.35 [95% confidence interval 1.05-1.75]) and IVH grade 3 to 4 (adjusted odds ratio 4.26 [3.25-5.59]). Children with IVH grade 1 to 2 had higher risks of cerebral palsy (odds ratio [OR] 1.76 [1.39-2.24]), cognitive (OR 1.79 [1.09-2.95]), hearing (OR 1.83 [1.03-3.24]), and visual impairment (OR 1.77 [1.08-2.9]). Children with IVH grade 3 to 4 had markedly higher risks of cerebral palsy (OR 4.98 [4.13-6.00]), motor (OR 2.7 [1.52-4.8]), cognitive (OR 2.3 [1.67-3.15]), hearing (OR 2.44 [1.42-4.2]), and visual impairment (OR 5.42 [2.77-10.58]). Children with WMI had much higher risks of cerebral palsy (OR 14.91 [7.3-30.46]), motor (OR 5.3 [3-9.36]), and cognitive impairment (OR 3.48 [2.18-5.53]).
Limitations:
Heterogeneity of outcome data.
Conclusions:
Mild IVH, severe IVH, and WMI are associated with adverse neurodevelopmental outcomes. Utilization of core outcome sets and availability of open-access study data would improve our understanding of the nuances of these outcomes.
