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Published on: October 15, 2021
Childhood outcomes after low-grade intraventricular haemorrhage: A systematic review and meta-analysis
Philippa Rees1, Caitriona Callan2, Karan R Chadda3
1Population Policy and Practice, Great Ormond Street UCL Institute of Child Health, London, UK.
Insights
Low-grade intraventricular hemorrhage (IVH) in infants is linked to lower IQ and increased cerebral palsy risk in school-aged children. This condition is not benign and requires further investigation into its long-term impacts.
Area of Science:
- Neonatal research
- Pediatric neurology
- Developmental pediatrics
Background:
- Intraventricular hemorrhage (IVH) is a common complication in preterm infants.
- Low-grade IVH (grades 1 and 2) is often considered less severe, but its long-term neurodevelopmental effects require thorough examination.
Conclusions:
- Low-grade IVH is associated with specific neurodevelopmental impairments, including lower IQ and increased cerebral palsy risk.
- The findings challenge the notion that low-grade IVH is a benign condition.
- Further research is needed to understand the full functional impact of low-grade IVH.
Aim:
To undertake a systematic review and meta-analysis exploring school-age neurodevelopmental outcomes of children after low-grade intraventricular haemorrhage (IVH).
Method:
The published and grey literature was extensively searched to identify observational comparative studies exploring neurodevelopmental outcomes after IVH grades 1 and 2. Our primary outcome was neurodevelopmental impairment after 5 years of age, which included cognitive, motor, speech and language, behavioural, hearing, or visual impairments.
Results:
This review included 12 studies and over 2036 infants born preterm with low grade IVH. Studies used 30 different neurodevelopmental tools to determine outcomes. There was conflicting evidence of the composite risk of neurodevelopmental impairment after low-grade IVH. There was evidence of an association between low-grade IVH and lower IQ at school age (-4.23, 95% confidence interval [CI] -7.53, -0.92, I2 = 0%) but impact on school performance was unclear. Studies reported an increased crude risk of cerebral palsy after low-grade IVH (odds ratio [OR] 2.92, 95% CI 1.95, 4.37, I2 = 41%). No increased risk of speech and language impairment or behavioural impairment was found. Few studies addressed hearing and visual impairment.
Interpretation:
This systematic review presents evidence that low-grade IVH is associated with specific neurodevelopmental impairments at school age, lending support to the theory that low-grade IVH is not a benign condition.
What This Paper Adds:
The functional impact of low-grade intraventricular haemorrhage (IVH) at school age is unknown. Low-grade IVH is associated with a lower IQ at school age. The risk of cerebral palsy is increased after low-grade IVH. Low-grade IVH is not associated with speech and language impairment.
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