Temporal Trends in Severe Brain Injury and Associated Outcomes in Very Preterm Infants

Area of Science:

• Neonatalogy
• Pediatric Neurology
• Clinical Perinatology

Background:

• Severe brain injury (SBI), including severe intraventricular haemorrhage (sIVH), presents substantial challenges for preterm infants.
• Recent data and trends regarding SBI and its impact on vulnerable preterm populations are limited.

Purpose of the Study:

• To analyze the occurrence and temporal trends of SBI and sIVH in preterm infants.
• To assess the rates and trends of death and neurodevelopmental impairment (NDI) in infants with SBI.

Main Methods:

• Utilized data from the Australian and New Zealand Neonatal Network for preterm infants (<32 weeks' gestation).
• Analyzed admissions at Monash Children's Hospital from January 2014 to April 2021.
• Assessed SBI, sIVH, mortality, and NDI rates and their temporal trends.

Main Results:

• 6.7% of 1,609 preterm infants experienced SBI, with 5.6% having sIVH.
• 37.6% of infants with SBI did not survive, often following care redirection.
• 65.2% of SBI survivors developed cerebral palsy, and 86.4% had NDI.

Conclusions:

• Neither SBI nor its composite outcome of death or NDI showed statistically significant improvement over time.
• A significant proportion of preterm infants with SBI experienced mortality or severe NDI.
• There is an urgent need for improved therapeutic interventions to enhance outcomes for preterm infants with SBI.