Intraventricular Hemorrhage and Developmental Outcomes at 24 Months of Age in Extremely Preterm Infants

Whether intraventricular hemorrhage increases the risk of adverse developmental outcome among premature infants is controversial. Using brain ultrasound, we identified intraventricular hemorrhage and white matter abnormalities among 1064 infants born before 28 weeks’ gestation. We identified adverse developmental outcomes at 24 months of age using a standardized neurologic examination and the Bayley Scales of Infant Development Mental and Motor Scales. In logistic regression models that adjusted for gestational age, sex, and public insurance, isolated intraventricular hemorrhage was associated with visual fixation difficulty but no other adverse outcome. Infants who had a white matter lesion unaccompanied by intraventricular hemorrhage were at increased risk of cerebral palsy, low Mental and Motor Scores, and visual and hearing impairments. Except when accompanied or followed by a white matter lesion, intraventricular hemorrhage is associated with no more than a modest increase (and possibly no increase) in the risk of adverse developmental outcome during infancy.

[1]  M. D. Del Bigio.  Cell proliferation in human ganglionic eminence and suppression after prematurity-associated haemorrhage. , 2011, Brain : a journal of neurology.

[2]  B. E. Gridley,et al.  Review of the Bayley Scales of Infant Development—Second edition , 1994 .

[3]  J. Soul,et al.  Video and CD-ROM as a Training Tool for Performing Neurologic Examinations of 1-Year-Old Children in a Multicenter Epidemiologic Study , 2005, Journal of child neurology.

[4]  Nigel Paneth,et al.  Cranial Ultrasound Lesions in the NICU Predict Cerebral Palsy at Age 2 Years in Children Born at Extremely Low Gestational Age , 2009, Journal of child neurology.

[5]  J. Pinto-Martin,et al.  Neonatal head ultrasound abnormalities in preterm infants and adolescent psychiatric disorders. , 2011, Archives of general psychiatry.

[6]  J. Pinto-Martin,et al.  Neonatal cranial ultrasound abnormalities in low birth weight infants: relation to cognitive outcomes at six years of age. , 1996, Pediatrics.

[7]  N. Paneth,et al.  Classifying brain damage in preterm infants. , 1999, The Journal of pediatrics.

[8]  N Marlow,et al.  The EPICure study: associations and antecedents of neurological and developmental disability at 30 months of age following extremely preterm birth , 2005, Archives of Disease in Childhood - Fetal and Neonatal Edition.

[9]  M. O'Shea,et al.  An algorithm for identifying and classifying cerebral palsy in young children. , 2008, The Journal of pediatrics.

[10]  L. Papile,et al.  Relationship of cerebral intraventricular hemorrhage and early childhood neurologic handicaps. , 1983, The Journal of pediatrics.

[11]  D. J. Goldstein,et al.  Neonatal Cranial Ultrasound Lesions and Developmental Delays at 2 Years of Age Among Extremely Low Gestational Age Children , 2008, Pediatrics.

[12]  M. Kramer,et al.  Very low birth weight: a problematic cohort for epidemiologic studies of very small or immature neonates. , 1991, American journal of epidemiology.

[13]  M. R. Bigio,et al.  Cell proliferation in human ganglionic eminence and suppression after prematurity-associated haemorrhage , 2011 .

[14]  L. D. de Vries,et al.  Ultrasound abnormalities preceding cerebral palsy in high-risk preterm infants. , 2004, The Journal of pediatrics.

[15]  D. Wilson‐Costello,et al.  Grades I-II intraventricular hemorrhage in extremely low birth weight infants: effects on neurodevelopment. , 2006, The Journal of pediatrics.

[16]  Mark Schluchter,et al.  Poor Predictive Validity of the Bayley Scales of Infant Development for Cognitive Function of Extremely Low Birth Weight Children at School Age , 2005, Pediatrics.

[17]  S. Counsell,et al.  Magnetic resonance and ultrasound brain imaging in preterm infants. , 2005, Early human development.

[18]  M. Smrkovsky,et al.  Bayley Scales of Infant Development - Second Edition (BSID-II)) , 2003 .

[19]  A. Whitelaw,et al.  Posthaemorrhagic ventricular dilatation: new mechanisms and new treatment , 2004, Acta paediatrica (Oslo, Norway : 1992). Supplement.

[20]  A. Wilkinson,et al.  New birthweight and head circumference centiles for gestational ages 24 to 42 weeks. , 1987, Early human development.

[21]  J. Pinto-Martin,et al.  Cranial ultrasound prediction of disabling and nondisabling cerebral palsy at age two in a low birth weight population. , 1995, Pediatrics.

[22]  Barbara J. Stoll,et al.  Neurodevelopmental Outcome of Extremely Low Birth Weight Infants With Posthemorrhagic Hydrocephalus Requiring Shunt Insertion , 2008, Pediatrics.

[23]  Eung Yeop Kim,et al.  Motor pathway injury in patients with periventricular leucomalacia and spastic diplegia. , 2011, Brain : a journal of neurology.

[24]  E Kazam,et al.  White matter disorders of prematurity: association with intraventricular hemorrhage and ventriculomegaly. The Developmental Epidemiology Network. , 1999, The Journal of pediatrics.

[25]  M. Schluchter,et al.  Consequences and Risks of <1000-g Birth Weight for Neuropsychological Skills, Achievement, and Adaptive Functioning , 2006, Journal of developmental and behavioral pediatrics : JDBP.

[26]  A. Leviton,et al.  Observer variability assessing US scans of the preterm brain: the ELGAN study , 2007, Pediatric Radiology.

[27]  J. Wyatt,et al.  PROBABILITÉ OF NEURODEVELOPMENTAL DISORDERS ESTIMATED FROM ULTRASOUND APPEARANCE OF BRAINS OF VERY PRETERM INFANTS , 1987, Developmental medicine and child neurology.

[28]  L. Doyle,et al.  The stability of the diagnosis of developmental disability between ages 2 and 8 in a geographic cohort of very preterm children born in 1997 , 2009, Archives of Disease in Childhood.

[29]  D. Hirtz,et al.  The ELGAN study of the brain and related disorders in extremely low gestational age newborns. , 2009, Early human development.