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Updated: Aug 6, 2025
Modeling Neonatal Intraventricular Hemorrhage Through Intraventricular Injection of Hemoglobin
Published on: August 25, 2022
Intraventricular Hemorrhage in Very Preterm Children: Mortality and Neurodevelopment at Age 5
Ludovic Tréluyer1,2, Marie Chevallier3,4, Pierre-Henri Jarreau1,2
1CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, Université Paris Cité, Paris, France.
Insights
High-grade intraventricular hemorrhage (IVH) in premature infants is linked to significant mortality, often due to treatment withdrawal. Survivors with severe IVH face a high risk of neurodevelopmental disabilities.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Developmental Pediatrics
Background:
- Intraventricular hemorrhage (IVH) is a common complication in premature infants.
- Understanding the long-term neurodevelopmental impact of IVH is crucial for clinical management.
Purpose of the Study:
- To investigate mortality and causes of death in children with IVH.
- To assess neurodevelopmental outcomes at age 5 in children with a history of IVH.
Main Methods:
- Secondary analysis of the French EPIPAGE-2 cohort, including infants born before 32 weeks gestation.
- IVH classified using Papile criteria; neurodevelopmental assessment at age 5.
- Outcomes included mortality, cause of death, and neurodevelopmental disabilities.
Main Results:
- High-grade IVH (grade 3) had a 29.7% mortality rate; intraparenchymal hemorrhage (IPH) had a 74.4% mortality rate.
- Most deaths were due to withholding/withdrawing life-sustaining treatment.
- Low-grade IVH showed no association with neurodevelopmental disabilities; high-grade IVH was associated with moderate/severe disabilities, reduced IQ, and cerebral palsy.
Conclusions:
- High-grade IVH significantly increases mortality risk, primarily due to treatment decisions.
- Survivors of high-grade IVH have a substantially higher likelihood of experiencing neurodevelopmental disabilities at age 5.
Objectives:
The objectives were to describe mortality and causes of death in children with intraventricular hemorrhage (IVH) and to study neurodevelopmental outcomes.
Methods:
The study was a secondary analysis of the French national prospective and population-based cohort EPIPAGE-2. Children were recruited in 2011. A standardized assessment was conducted at age 5. Children born before 32 weeks' gestation and admitted to a NICU were eligible. Exposure was IVH defined by the Papile classification. Main outcomes were mortality, causes of death, and neurodevelopmental outcomes at age 5.
Results:
Among the 3468 children included, 578 (16.7%) had grade 1 IVH, 424 (12.2%) grade 2 IVH, and 114 (3.3%) grade 3 IVH; 144 (4.1%) had intraparenchymal hemorrhage (IPH). Mortality was 29.7% (36 of 114) for children with grade 3 IVH and 74.4% (109 of 144) for those with IPH; 67.6% (21 of 31) and 88.7% (86 of 97) of deaths, respectively, were because of withholding and withdrawing of life-sustaining treatment. As compared with no IVH, low-grade IVH was not associated with measured neurodevelopmental disabilities at age 5. High-grade IVH was associated with moderate and severe neurodevelopmental disabilities, reduced full-scale IQ, and cerebral palsy.
Conclusions:
Rates of neurodevelopmental disabilities at age 5 did not differ between children without IVH and those with low-grade IVH. For high-grade IVH, mortality rate was high, mostly because of withholding and withdrawal of life-sustaining treatment, and we found a strong association with overall neurodevelopmental disabilities in survivors.
