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Updated: Jan 7, 2026
Modeling Neonatal Intraventricular Hemorrhage Through Intraventricular Injection of Hemoglobin
Published on: August 25, 2022
School Performance of Preterm-Born Children After Intraventricular Hemorrhage
Philippa Rees1, Mithilesh Dronavalli2, Ben Carter3
1Population Policy and Practice, University College London Institute of Child Health, London, United Kingdom.
Insights
Intraventricular hemorrhage (IVH) in preterm infants can impact school performance. High-grade IVH is linked to poorer academic outcomes, while low-grade IVH shows limited effects, emphasizing the need for continued educational support for all preterm children.
Area of Science:
- Neonatal care
- Pediatric neurology
- Educational psychology
Background:
- Intraventricular hemorrhage (IVH) is a common complication in preterm infants, affecting about 20% of this population.
- The long-term academic consequences of IVH, beyond those attributed to prematurity alone, remain understudied, creating a significant knowledge gap.
Purpose of the Study:
- To examine the association between intraventricular hemorrhage (IVH) and national school performance in children from childhood through adolescence.
- To compare academic outcomes between very preterm infants with varying grades of IVH and their peers.
Main Methods:
- A population-based cohort study in New South Wales, Australia, included very preterm infants (<32 weeks' gestation) and full-term controls.
- Cohorts comprised very preterm infants with low-grade (1-2) or high-grade (3-4) IVH, very preterm controls without IVH, and full-term controls.
- National standardized school assessments were analyzed for overall and domain-specific performance at ages 8-9, 10-11, and 12-13 years.
Main Results:
- Children with high-grade IVH consistently performed significantly worse than very preterm controls across all assessed age groups.
- Low-grade IVH (grades 1-2) showed limited impact, except for grade 2 IVH, which was associated with poorer performance at age 8-9.
- Numeracy was a particular area of difficulty for children with high-grade IVH; academic trajectories showed improvement over time but group differences remained fixed.
Conclusions:
- High-grade intraventricular hemorrhage is associated with persistent academic deficits into adolescence.
- While low-grade IVH has a limited impact, grade 2 IVH warrants attention. Educational support is crucial for all preterm children to achieve their potential.
- This study highlights the importance of monitoring academic progress in preterm infants with IVH and providing tailored educational interventions.
Importance:
Intraventricular hemorrhage (IVH) is a significant complication of preterm birth, affecting approximately 20% of preterm infants. Despite its prevalence, the effect of IVH beyond the impact of prematurity alone has been scarcely studied beyond early childhood, posing an important knowledge gap.
Objective:
To investigate the association of IVH with national school performance throughout childhood to adolescence.
Design, Setting, And Participants:
This population-based cohort study included all very preterm infants (<32 weeks' gestation) and full-term infants (≥37 weeks' gestation) born in New South Wales, Australia, between January 1, 2007, and December 31, 2013. Cohorts were very preterm children with low-grade (grades 1-2) or high-grade (grades 3-4) IVH, very preterm controls without IVH, and full-term controls. Analyses were conducted from January 30 to September 18, 2024.
Exposure:
IVH grade 1 to 4.
Main Outcomes And Measures:
The primary outcome was overall performance on standardized national school assessments at age 8 to 9, 10 to 11, and 12 to 13 years, including adjusted mean differences (AMDs) in z scores between children with IVH and very preterm controls. Secondary outcomes were domain-specific performance in reading, writing, spelling, grammar, and numeracy and whether children met the national minimum standards overall and for each domain. Academic trajectories were also compared by group.
Results:
This study included 408 189 children: 557 with low-grade IVH, 85 with high-grade IVH, 2557 very preterm controls without IVH, and 404 990 full-term controls. Children with low-grade IVH performed similarly to preterm controls at age 8 to 9 years (AMD in overall academic z score, -0.06; 95% CI, -0.14 to 0.03), 10 to 11 years (AMD, -0.09; 95% CI, -0.21 to 0.03), and 12 to 13 years (AMD, -0.04; 95% CI, -0.24 to 0.16). Children with grade 2 IVH (n = 145), however, performed significantly worse than very preterm controls at age 8 to 9 years (AMD, -0.20; 95% CI, -0.36 to -0.04). Children with high-grade IVH performed significantly worse than very preterm controls at age 8 to 9 years (AMD, -0.50; 95% CI, -0.71 to -0.30), 10 to 11 years (AMD, -0.59; 95% CI, -0.85 to -0.34), and 12 to 13 years (AMD, -0.61; 95% CI, -1.05 to -0.17). Numeracy was a consistently weak domain for children with high-grade IVH throughout school age (eg, at age 8 to 9 years, AMD in the numeracy z score compared with very preterm controls was -0.49 [95% CI, -0.70 to -0.28]). Differences in academic trajectories between groups remained fixed with increasing age; however, all groups showed improvement over time (eg, adjusted β for very preterm children, 32.3 [95% CI, 31.2-33.5]; children with low-grade IVH, 31.5 [95% CI, 29.0-34.0]; high-grade IVH, 30.2 [95% CI, 24.1-36.4]).
Conclusions And Relevance:
In this cohort study, the association of low-grade IVH with worse school performance appeared limited to children with grade 2 IVH. Children with high-grade IVH consistently showed poorer academic performance into adolescence than their peers born very preterm without IVH. Nevertheless, very preterm children, regardless of IVH grade, demonstrated academic progress over time, underscoring the need for ongoing educational support to help them to realize their full potential.
