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Low-Grade Germinal Matrix Hemorrhage-Intraventricular Hemorrhage and Concomitant Preterm Brain Injuries:

Marta Ybarra1, Vann Chau1, Stephanie H Au-Young1

  • 1Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada.

The Journal of Pediatrics
|July 4, 2025
PubMed

Insights

Low-grade germinal matrix hemorrhage-intraventricular hemorrhage (GMH-IVH) in preterm infants did not significantly impact neurodevelopment. However, co-occurring cerebellar hemorrhage (CbH) or white matter injury (WMI) was linked to poorer outcomes.

Area of Science:

  • Neonatal Neurology
  • Neurodevelopmental Pediatrics
  • Pediatric Radiology

Background:

  • Germinal matrix hemorrhage-intraventricular hemorrhage (GMH-IVH) is a common complication in preterm infants.
  • Low-grade GMH-IVH (grades 1 and 2) is often considered to have a better prognosis, but its long-term neurodevelopmental impact requires further investigation.
  • The potential influence of associated injuries like white matter injury (WMI) and cerebellar hemorrhage (CbH) on outcomes needs clarification.

Purpose of the Study:

  • To assess neurodevelopmental outcomes at 3 years of age in preterm infants with low-grade GMH-IVH.
  • To determine the impact of isolated low-grade GMH-IVH versus GMH-IVH with co-occurring WMI or CbH.
  • To investigate the relationship between the volume of CbH and WMI and neurodevelopmental deficits.

Main Methods:

  • A prospective cohort of 175 preterm infants (<32 weeks gestation) was enrolled.
  • Brain MRI was performed in the neonatal period and at term-equivalent age to assess GMH-IVH, WMI, and CbH.
  • Neurodevelopmental assessments were conducted at 3 years of corrected age.

Main Results:

  • Low-grade GMH-IVH was detected in 53% of infants, with 78% of these being grades 1 or 2.
  • Infants with low-grade GMH-IVH showed higher rates of WMI and CbH compared to those without GMH-IVH.
  • Low-grade GMH-IVH combined with CbH >4 mm was associated with lower language scores.
  • Greater CbH volumes correlated with lower composite motor, cognitive, and language scores.
  • WMI volumes >40 mm³ in infants with low-grade GMH-IVH were linked to lower motor scores.

Conclusions:

  • Isolated low-grade GMH-IVH alone did not significantly impair 3-year neurodevelopmental outcomes.
  • The presence of concomitant cerebellar hemorrhage or white matter injury significantly worsened neurodevelopmental outcomes in preterm infants with low-grade GMH-IVH.
  • These findings highlight the importance of evaluating associated brain injuries in preterm infants with GMH-IVH for accurate prognostication.
Abstract

Keywords:
cerebellar hemorrhageintraventricular hemorrhagenewbornpretermwhite matter injury

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