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[Extremely preterm infants with severe intraventricular hemorrhage: neurological evolution and long term and
Rodrigo Salas Núñez1, Raquel Gaete Sepúlveda2, Javier Salas Fontecilla3
1Complejo Asistencial Barros Luco, Santiago, Chile.
Insights
Extensive intraventricular hemorrhage in very preterm newborns often leads to neurological issues. While two-thirds achieve good functional outcomes, one-third face mobility and cognitive challenges, impacting their schooling.
Area of Science:
- Neonatal Neurology
- Neurodevelopmental Pediatrics
- Pediatric Neurology
Background:
- Extensive intraventricular hemorrhage (IVH) in very preterm newborns (VPNB) is linked to significant mortality and long-term neurological deficits.
- Understanding the spectrum of neurological pathologies and functional outcomes is crucial for this vulnerable population.
Purpose of the Study:
- To identify common neurological conditions associated with extensive IVH in VPNB.
- To assess motor (mobility) and cognitive (intellectual capacity) functional outcomes.
- To analyze the relationship between motor and cognitive function and determine educational attainment.
Main Methods:
- A descriptive, longitudinal study followed VPNB with extensive IVH from 2001-2014.
- Neurological assessments were conducted until school age, categorizing functional outcomes into four levels (autonomy to total dependence).
- Statistical analyses included Chi-square and Cramer's V to examine associations.
Main Results:
- 74 children completed follow-up; common pathologies included neurodevelopmental disorders, hydrocephalus, and epilepsy.
- 74.4% achieved independent or limited mobility; 24.3% required wheelchairs.
- 51.3% had normal to borderline intellectual range; 19.9% had severe to profound intellectual disability.
Conclusions:
- Two-thirds of VPNB with extensive IVH experienced favorable outcomes with near-autonomous living.
- One-third had unfavorable outcomes in mobility and cognition, with a strong correlation between these domains.
- Educational attainment directly reflected intellectual capacity.
Abstract:
Extensive intraventricular hemorrhage (IVH) in very preterm newborns (VPNB) is associated with mortality and severe long-term neurological sequelae.
Objectives:
To know the most frequent neurological pathologies associated with extensive IVH, to determine the functional outcomes of mobility in the motor area and intellectual capacity in the cognitive area, to analyze the association between both areas and to know the schooling achieved.
Patients And Method:
Descriptive and longitudinal study in VPNB with extensive IVH born between 2001 and 2014. They underwent protocolized neurological follow-up until school age. The functional outcomes in mobility and intellectual capacity were categorized into 4 levels: level 1 corresponds to good functionality and autonomy; level 2, functionality that allows independence, with support in some tasks; level 3 requires constant external support; and level 4 where there is total dependence. The association was analyzed using Chi-square and Cramer's V coefficient.
Results:
74 children completed the follow-up; the most frequent associated neurological pathologies were neurodevelopmental disorders, hypertensive hydrocephalus, and epilepsy. Independent mobility (normal or with limitations) reached 74.4% while 24.3% used wheelchairs. 51.3% was categorized as normal to borderline intellectual range, 12.2% as mild intellectual disability (ID), 17.6% as moderate ID, and 19.9% as severe to profound ID. There was a strong statistical association between functional levels of mobility and intellectual capacity (p < 0.000 and V = 0.62). Schooling was proportional to intellectual capacity: 56.8% attended regular schools, 27.0% attended special schools, and 16.2% had no schooling.
Conclusions:
2/3 VPNB with extensive IVH showed positive functional outcomes, from normal to mild limitations that allow an almost autonomous life; in 1/3 the outcomes were unfavorable in mobility and cognitive performance, and there was a strong statistical correlation between both areas studied. Schooling was consistent with the intellectual level.
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