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Updated: Aug 16, 2025
Modeling Neonatal Intraventricular Hemorrhage Through Intraventricular Injection of Hemoglobin
Published on: August 25, 2022
Grading of Intraventricular Hemorrhage and Neurodevelopment in Preterm <29 Weeks’ GA in Canada
Vibhuti Shah1,2, Natasha Musrap1, Krishanta Maharaj1
1Department of Paediatrics, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada.
Insights
Preterm infants with severe intraventricular hemorrhages (IVH) grades III-IV face higher risks of neurodevelopmental impairment (NDI). Even mild IVH (grades I-II) is linked to increased significant NDI, impacting preterm infant outcomes.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
- Perinatal medicine
Background:
- Intraventricular hemorrhage (IVH) is a common complication in preterm infants.
- The impact of IVH severity on long-term neurodevelopmental outcomes requires further elucidation.
- Understanding these risks is crucial for targeted interventions and improved care for vulnerable neonates.
Purpose of the Study:
- To evaluate the 18–24 month neurodevelopmental outcomes of preterm infants with varying grades of intraventricular hemorrhage (IVH).
- To compare outcomes between infants with grades I–IV IVH and those without IVH.
- To assess the influence of IVH severity and associated neonatal morbidities on neurodevelopmental impairment (NDI).
Main Methods:
- Retrospective cohort study of preterm infants (<29 weeks’ gestational age) from the Canadian Neonatal Network.
- Infants were grouped by IVH severity (none, grades I–II, grade III, grade IV) based on cranial ultrasound scans.
- Neurodevelopmental impairment (NDI) and significant NDI (sNDI) were assessed at 18–24 months using multivariable regression analysis.
Main Results:
- Infants with grades III and IV IVH showed significantly higher odds of NDI compared to those without IVH.
- While infants with grades I–II IVH had similar NDI rates, they exhibited increased odds of sNDI.
- The study included 2327 preterm infants, providing robust statistical power for the observed associations.
Conclusions:
- Increased odds of significant neurodevelopmental impairment (sNDI) are associated with grades I–II IVH in preterm infants.
- Severe IVH (grades III–IV) is linked to a higher risk of adverse neurodevelopmental impairment (NDI).
- These findings align with existing literature and underscore the importance of monitoring neurodevelopmental trajectories following IVH.
Abstract:
Objective: The aim of this study was to evaluate the neurodevelopmental outcome at 18−24 months in surviving preterm infants with grades I−IV intraventricular hemorrhages (IVHs) compared to those with no IVH. Study Design: We included preterm survivors <29 weeks’ GA admitted to the Canadian Neonatal Network’s NICUs from April 2009 to September 2011 with follow-up data at 18−24 months in a retrospective cohort study. The neonates were grouped based on the severity of the IVH detected on a cranial ultrasound scan and recorded in the database: no IVH; subependymal hemorrhage or IVH without ventricular dilation (grades I−II); IVH with ventricular dilation (grade III); and persistent parenchymal echogenicity/lucency (grade IV). The primary outcomes of neurodevelopmental impairment (NDI), significant neurodevelopmental impairment (sNDI), and the effect modification by other short-term neonatal morbidities were assessed. Using multivariable regression analysis, the adjusted ORs (AOR) and 95% of the CIs were calculated. Results: 2327 infants were included. The odds of NDI were higher in infants with grades III and IV IVHs (AOR 2.58, 95% CI 1.56, 4.28 and AOR 2.61, 95% CI 1.80, 3.80, respectively) compared to those without IVH. Infants with an IVH grade ≤II had similar outcomes for NDI (AOR 1.08, 95% CI 0.86, 1.35) compared to those without an IVH, but the odds of sNDI were higher (AOR 1.58, 95% CI 1.16, 2.17). Conclusions: There were increased odds of sNDI in infants with grades I−II IVHs, and an increased risk of adverse NDI in infants with grades ≥III IVHs is corroborated with the current literature.
